ABSTRACT
BACKGROUND: This study was performed to determine whether in-laboratory specimen radiography reduces turnaround time or block utilization in surgical pathology. METHODS: Specimens processed during a 48-day trial of an in-lab cabinet radiography device (Faxitron) were compared to a control group of specimens imaged in the mammography suite during a prior 1-year period, and to a second group of specimens not undergoing imaging of any type. RESULTS: Cases imaged in the mammography suite had longer turnaround time than cases not requiring imaging (by 1.15 days for core biopsies, and 1.73 days for mastectomies; p < 0.0001). In contrast, cases imaged in-lab had turnaround time that was no longer than unimaged cases (p > 0.05 for core biopsies, lumpectomies and mastectomies). Mastectomies imaged in-lab required submission of fewer blocks than controls not undergoing any imaging (mean reduction of 10.6 blocks). CONCLUSIONS: Availability of in-lab radiography resulted in clinically meaningful improvements in turnaround time and economically meaningful reductions in block utilization.
Subject(s)
Breast/diagnostic imaging , Laboratories, Clinical , Mammography/statistics & numerical data , Pathology, Surgical/methods , Specimen Handling/methods , Biopsy, Large-Core Needle/statistics & numerical data , Breast/pathology , Breast/surgery , Calcinosis/diagnostic imaging , Calcinosis/pathology , Female , Fiducial Markers , Humans , Laboratories, Clinical/economics , Mastectomy, Modified Radical/statistics & numerical data , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Pathology, Surgical/economics , Pathology, Surgical/instrumentation , Pathology, Surgical/organization & administration , Specimen Handling/economics , Specimen Handling/instrumentation , Specimen Handling/statistics & numerical data , Time Factors , Tissue Embedding/statistics & numerical dataSubject(s)
Breast Neoplasms , Mammaplasty , Mastectomy, Segmental , Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , Female , Humans , Mammaplasty/methods , Mammaplasty/statistics & numerical data , Mastectomy, Segmental/methods , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Segmental/trends , Mastectomy, Simple/methods , Mastectomy, Simple/statistics & numerical data , Outcome and Process Assessment, Health Care , Patient Selection , Procedures and Techniques Utilization , Prophylactic Mastectomy/methods , Prophylactic Mastectomy/statistics & numerical data , United States/epidemiologyABSTRACT
The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI-confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI -0.07, 0.37), emotional health (k = 13; -0.08, 95% CI - 0.41, 0.25), global health (k = 7; 0.1, 95% CI - 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI - 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.
Subject(s)
Breast Neoplasms/surgery , Cancer Survivors/psychology , Mammaplasty/psychology , Mastectomy, Segmental/psychology , Mastectomy, Simple/psychology , Quality of Life , Body Image , Breast , Breast Neoplasms/psychology , Cancer Survivors/statistics & numerical data , Female , Humans , Mammaplasty/statistics & numerical data , Mastectomy, Segmental/adverse effects , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/adverse effects , Mastectomy, Simple/statistics & numerical data , Surveys and Questionnaires/statistics & numerical dataABSTRACT
OBJECTIVES: To evaluate the impact of systematic radiological review by breast specialist radiologist of malignant breast lesion imaging on the therapeutic management of patients. MATERIALS AND METHODS: Data collection was performed for patients with histopathologically proved breast cancer or suspicious breast lesion on imaging realized out of our institution. Patients underwent systematic mammary and axillary ultrasound, imaging review and if necessary complementary mammographic images. We analyzed the number of additional breast biopsies and axillary lymph node fine needle aspiration (FNA) with their histopathological results. We assessed their impact by comparing the final surgical treatment to the one planned before review. RESULTS: Two hundred and seventeen patients were included, with a total of 230 BIRADS 0, 4, 5 or 6 breast lesions. Seventy-six additional breast core biopsies were realized, leading to diagnose 43 additional BIRADS 6 lesions (24 infiltrative carcinomas, 9 DCIS and 10 atypical lesions) in 30 patients (13.82%). Thirty-five additional lymph node FNA were realized with 12 metastatic nodes and 3 false negative samples. Imaging review lead to change surgical treatment in 59 patients (27.19%, P<0.01) with modification in breast surgery in 37 patients, axillary surgery in 8 patients and both sites surgery in 12 patients. CONCLUSION: This study shows an impact of systematic radiological review by breast specialist radiologist in therapeutic management of patients treated for malignant breast lesion.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/therapy , Lymph Nodes/diagnostic imaging , Radiologists , Adult , Aged , Axilla , Biopsy, Fine-Needle/statistics & numerical data , Breast/diagnostic imaging , Breast/pathology , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Calcinosis/diagnostic imaging , Chemotherapy, Adjuvant/statistics & numerical data , Chi-Square Distribution , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , Mammography , Mastectomy/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Middle Aged , Preoperative Period , Radiation Oncology , Retrospective Studies , Statistics, Nonparametric , Ultrasonography, Mammary/statistics & numerical dataABSTRACT
BACKGROUND: Comparative studies suggest that patients treated with oncoplastic breast conservation surgery (OBCS) have similar pathology to patients treated with wide local excision (WLE). However, patients treated with OBCS have never been compared to patients treated with mastectomy. The aim of this study was to identify which control group was comparable to patients undergoing OBCS. METHODS: Commonly reported histopathological variables of patients treated with OBCS, WLE or mastectomy ± immediate reconstruction (Ms ± IR) were compared using Fisher Exact or Chi squared tests. RESULTS: 1000 patients' data were analysed (OBCS: n = 119; WLE: n = 600; Ms ± IR: n = 281). Tumour size was significantly bigger after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.138). Tumour grade was higher after OBCS than WLE (p < 0.001), but similar to Ms ± IR (p = 0.497). More axillary nodes were involved in patients with OBCS than WLE (p < 0.001), but comparable to Ms ± IR (p = 0.175). ER and PR expressions were lower after OBCS compared to WLE (p = 0.007, p = 0.009), but identical to Ms ± IR (p = 1, p = 0.904 respectively). Differences in application of systemic (neo)adjuvant therapy followed the above trend. CONCLUSION: Striking similarities found between OBCS and mastectomy patients' histopathological results are in sharp contrast with previously published data. This study suggests that oncological outcomes following OBCS should be compared to mastectomy besides WLE.
Subject(s)
Breast Neoplasms/surgery , Mammaplasty/statistics & numerical data , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Adult , Aged , Axilla , Breast Neoplasms/pathology , Chi-Square Distribution , Combined Modality Therapy , Databases, Factual , Female , Humans , Lymph Nodes/pathology , Mastectomy, Segmental/methods , Middle Aged , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
La enfermedad de Paget de la mama es una entidad poco frecuente y de buen pronóstico. El tratamiento clásico ha sido la mastectomía, pero es posible una cirugía conservadora de la mama, y hoy en día debe valorarse como primera opción siempre y cuando se aseguren márgenes libres con un resultado estético aceptable. Las pruebas de imagen son fundamentales para descartar un carcinoma subyacente y de cara a la planificación de una cirugía conservadora, así como para el futuro seguimiento de estas pacientes
Paget disease of the breast is a relatively rare entity with a favourable prognosis. Form any years, the gold standard treatment has been mastectomy. However, breast-conserving surgery is now feasible and should be evaluated as the first-line option whenever negative margins with acceptable cosmetic results can be achieved. Imaging techniques are essential to exclude an underlying carcinoma and play an important role in selecting candidates for breast-conserving treatment and in follow-up
Subject(s)
Humans , Female , Paget's Disease, Mammary/epidemiology , Mastectomy, Segmental/statistics & numerical data , Breast Neoplasms/surgery , Mastectomy, Simple/statistics & numerical data , Mastectomy, Radical/statistics & numerical dataABSTRACT
BACKGROUND: The surgical approach to breast cancer changed dramatically in the past 20 years. The surgical objective today is to remove the tumor, ensuring negative margins and good cosmetic results, and preserving the breast when possible. Magnetic resonance imaging of the breast has become an essential imaging tool prior to surgery, diagnosing additional tumors and assessing tumor extent. Tumor-to-breast volume ratio, an important predictor of breast conservation, can be measured with MRI and may change the surgical decision. OBJECTIVES: To measure the tumor-to-breast volume ratio using MRI in order to assess whether there is a correlation between this ratio and the type of surgery selected (breast-conserving or mastectomy). METHODS: The volumes of the tumor and the breast and the tumor-to-breast volume ratio were retrospectively calculated using preoperative breast MRI in 76 patients who underwent breast-conserving surgery or mastectomy. RESULTS: Breast-conserving surgery (lumpectomy) was performed in 64 patients and mastectomy in 12. The average tumor-to-breast volume ratio was 0.06 (6%) in the lumpectomy group and 0.30 (30%) in the mastectomy group (P < 0.0001). CONCLUSION: The tumor-to-breast volume ratio correlated with the type of surgery. As measured on MRI, this ratio is an accurate means of determining the type of surgery best suited for a given patient. It is recommended that MRI-determined tumor-to-breast volume ratio become part of the surgical planning protocol for patients diagnosed with breast cancer.
Subject(s)
Breast Neoplasms , Breast , Magnetic Resonance Imaging , Mastectomy, Segmental , Mastectomy, Simple , Adult , Aged , Breast/pathology , Breast/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Decision Support Techniques , Female , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/statistics & numerical data , Mastectomy, Segmental/methods , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/methods , Mastectomy, Simple/statistics & numerical data , Middle Aged , Organ Size , Organ Sparing Treatments , Patient Care Planning , Predictive Value of Tests , Retrospective Studies , Statistics as Topic , Tumor BurdenABSTRACT
BACKGROUND: A Web-based synoptic operative reporting system (WebSMR) incorporates implicit guidelines and real-time feedback of a surgeon's practice compared with provincial data. This study compares rates of total mastectomy (TM) between the overall provincial and WebSMR patients and examines decision-making factors in WebSMR patients. METHODS: Patients treated for invasive breast cancer (2007 to 2011) were identified from WebSMR and the Alberta Cancer Registry. Reports include surgery type and reasons for TM. RESULTS: Among 5,787 patients in WebSMR (2007 to 2011), TM rate decreased from 48% to 42% (P < .001). In 2011, the provincial cancer registry recorded a 56% TM rate compared to 42% in WebSMR patients. Patient preference accounted for 36% in the latter group. CONCLUSIONS: In WebSMR patients, TM rates were lower than the overall provincial rate and decreased significantly during the study period. Reasons are unclear, but guidelines and real-time feedback likely plays a role.
Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Guideline Adherence/statistics & numerical data , Internet , Mastectomy, Simple/statistics & numerical data , Medical Records Systems, Computerized , Practice Patterns, Physicians'/statistics & numerical data , Alberta , Decision Support Techniques , Female , Guideline Adherence/trends , Humans , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Segmental/trends , Mastectomy, Simple/trends , Patient Preference , Practice Guidelines as Topic , Practice Patterns, Physicians'/trends , RegistriesABSTRACT
BACKGROUND: Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not entirely clear. Using a multi-institution database, we analyzed how practice, patient, and tumor characteristics contributed to variation in TM for invasive breast cancer. STUDY DESIGN: We collected detailed clinical and pathologic data about breast cancer diagnosis, initial, and subsequent breast cancer operations performed on all female patients from 4 participating institutions from 2003 to 2008. We limited this analysis to 2,384 incident cases of invasive breast cancer, stages I to III, and excluded patients with clinical indications for mastectomy. Predictors of initial TM were identified with univariate analyses and random effects multivariable logistic regression models. RESULTS: Initial TM was performed on 397 (16.7%) eligible patients. Use of preoperative MRI more than doubled the rate of TM (odds ratio [OR] = 2.44; 95% CI, 1.58-3.77; p < 0.0001). Increasing tumor size, high nuclear grade, and age were also associated with increased rates of initial TM. Differences by age and ethnicity were observed, and significant variation in the frequency of TM was seen at the individual surgeon level (p < 0.001). Our results were similar when restricted to tumors <20 mm. CONCLUSIONS: We identified factors associated with initial TM, including preoperative MRI and individual surgeon, that contribute to the current debate about variation in use of TM for the management of breast cancer. Additional evaluation of patient understanding of surgical options and outcomes in breast cancer and the impact of the surgeon provider is warranted.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Mastectomy, Simple/statistics & numerical data , Adult , Age Distribution , Age Factors , Aged , Female , Humans , Middle Aged , Multivariate Analysis , Neoplasm Grading , Odds Ratio , Risk Factors , United States/epidemiologySubject(s)
Breast Neoplasms/therapy , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Japan , Lymphatic Metastasis/diagnosis , Mastectomy, Segmental/trends , Mastectomy, Simple/trends , Registries , Sentinel Lymph Node Biopsy/statistics & numerical dataABSTRACT
BACKGROUND: Although the use of SSM is becoming more common, there are few data on long-term, local-regional, and distant recurrence rates after treatment. The purpose of this study was to examine the rates of local, regional, and systemic recurrence, and survival in breast cancer patients who underwent skin-sparing mastectomy (SSM) or conventional mastectomy (CM) at our institution. METHODS: Patients with stage 0 to III unilateral breast cancer who underwent total mastectomy at our center from 2000 to 2005 were included in this study. Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups. RESULTS: Of 1810 patients, 799 (44.1%) underwent SSM and 1011 (55.9%) underwent CM. Patients who underwent CM were older (58.3 vs 49.3 years, P<.0001) and were more likely to have stage IIB or III disease (53.0% vs 31.8%, P<.0001). Significantly more patients in the CM group received neoadjuvant chemotherapy and adjuvant radiation therapy (P<.0001). At a median follow-up of 53 months, 119 patients (6.6%) had local, regional, or systemic recurrences. The local, regional, and systemic recurrence rates did not differ significantly between the SSM and CM groups. After adjusting for clinical TNM stage and age, disease-free survival rates between the SSM and CM groups did not differ significantly. CONCLUSIONS: SSM is an acceptable treatment option for patients who are candidates for immediate breast reconstruction. Local-regional recurrence rates are similar to those of patients undergoing CM. Cancer 2011. © 2010 American Cancer Society.
Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Dermatologic Surgical Procedures , Mastectomy, Segmental/methods , Mastectomy, Simple/methods , Neoplasm Recurrence, Local/epidemiology , Adult , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/epidemiology , Carcinoma, Ductal, Breast/pathology , Databases, Factual , Disease-Free Survival , Female , Humans , Incidence , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Recurrence , Retrospective Studies , Young AdultABSTRACT
OBJECTIVES: We aimed to determine the incidence of women's breast cancer in Italy without using statistical approximations. METHODS: We analyzed the national hospitalizations database at the Ministry of Health to calculate the number of major surgeries in Italian women (mastectomies and quadrantectomies) due to breast cancer between 2000 and 2005, overall and by age groups (<44, 45-64, 65-74 and >or= 75 years old). RESULTS: Over the six years examined, an overall number of 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000 and this number rose to 47,200 in 2005, with a 13.4% increase over six years. CONCLUSION: by analyzing the hospitalizations database concerning major breast surgery, incidence of breast cancer in Italy was found to be 26.5% higher than the official estimations which have been computed using statistical models (namely 47,200 vs. 37,300 cases in year 2005).
Subject(s)
Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Adult , Aged , Breast Neoplasms/pathology , Databases, Factual , Female , Humans , Incidence , Italy/epidemiology , Middle Aged , Time Factors , Young AdultABSTRACT
BACKGROUND: Breast conservation therapy (BCT) is an oncologically equivalent and cosmetically preferable alternative to mastectomy for most early-stage breast cancers. The number of operations required to complete the surgical phase of therapy with BCT has not been widely reported. METHODS: From our institutional tumor registry, we reviewed the records of all patients receiving primary surgical therapy for breast cancer from January 1, 1998, to June 30, 2002. There were 204 patients with 210 breast cancers in the cohort. These cancers were initially managed with either BCT (n = 150) or mastectomy (modified radical mastectomy or total mastectomy with sentinel lymph node biopsy) (n = 60). We compared the percentages of patients in each group who required additional surgeries to obtain clear margins, manage axillary disease, or otherwise complete the surgical phase of therapy. Patients with secondary surgery related to long-term local recurrence were excluded. RESULTS: Fifty-one percent of patients initially managed with BCT required additional surgery compared with 12% in the mastectomy group (P <0.05). Factors independently associated with multiple surgeries among all patients included management with BCT (odds ratio [OR] 5.4, P = 0.01) and positive margins at initial excision (OR 4.7, P <0.01). Significant independent predictors of positive margins included BCT (OR 11.9, P <0.01); disease stage (OR 6.7, P <0.01); submission of supplemental margins in addition to the main specimen (OR 2.8, P = 0.03); and positive nodes (OR 1.1, P = 0.04). Breast conservation was ultimately successful in 95% of patients who underwent BCT. CONCLUSIONS: Patients undergoing BCT may require multiple surgeries to reconcile successful breast conservation with sound oncologic resection.
Subject(s)
Breast Neoplasms , Mastectomy, Segmental , Reoperation , Sentinel Lymph Node Biopsy , Aged , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Ductal/pathology , Carcinoma, Ductal/surgery , Carcinoma, Lobular/pathology , Carcinoma, Lobular/surgery , Female , Humans , Immunohistochemistry , Logistic Models , Male , Mastectomy, Modified Radical/adverse effects , Mastectomy, Modified Radical/methods , Mastectomy, Modified Radical/statistics & numerical data , Mastectomy, Segmental/adverse effects , Mastectomy, Segmental/methods , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/adverse effects , Mastectomy, Simple/methods , Mastectomy, Simple/statistics & numerical data , Middle Aged , Neoplasm Staging , Patient Selection , Predictive Value of Tests , Registries , Reoperation/adverse effects , Reoperation/methods , Reoperation/statistics & numerical data , Retrospective Studies , Sentinel Lymph Node Biopsy/adverse effects , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/statistics & numerical data , Treatment OutcomeABSTRACT
BACKGROUND: Women with metastatic breast cancer and an intact primary tumor are currently treated with systemic therapy. Local therapy of the primary tumor is considered irrelevant to the outcome, and is recommended only for palliation of symptoms. METHODS: We have examined the use of local therapy, and its impact on survival in patients presenting with stage IV breast cancer at initial diagnosis, who were reported to the National Cancer Data Base (NCDB) between 1990 and 1993. RESULTS: A total of 16,023 patients with stage IV disease were identified in the NCDB during this period, of whom 6861 (42.8%) received either no operation or a variety of diagnostic or palliative procedures, and 9162 (57.2%) underwent partial (3513) or total (5649) mastectomy. The presence of free surgical margins was associated with an improvement in 3-year survival in partial or total mastectomy groups (26% vs 35%, respectively). A multivariate proportional hazards model identified the number of metastatic sites, the type of metastatic burden, and the extent of resection of the primary tumor as significant independent prognostic covariates. Women treated with surgical resection with free margins, when compared with those not surgically treated, had superior prognosis, with a hazard ratio of 0.61 (95% confidence interval 0.58,0.65). CONCLUSIONS: These data suggest that the role of local therapy in women with stage IV breast cancer needs to be re-evaluated, and local therapy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.
Subject(s)
Breast Neoplasms/surgery , Mastectomy, Radical/methods , Mastectomy, Segmental/methods , Mastectomy, Simple/methods , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Mastectomy, Radical/statistics & numerical data , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Neoplasm Metastasis , Neoplasm Staging , Soft Tissue Neoplasms/mortality , Soft Tissue Neoplasms/secondary , Survival Rate , Time FactorsABSTRACT
BACKGROUND: Many women who are at an elevated risk of developing breast carcinoma choose prophylactic mastectomy to decrease their risk. We conducted a population-based study to review the indications for, and patterns of practice of prophylactic mastectomy in Ontario, Canada, since 1991. METHODS: A medical chart review was conducted at 33 hospitals that were identified as having conducted at least one prophylactic mastectomy. All bilateral mastectomy patients with no diagnosis of invasive or in situ breast carcinoma were eligible. RESULTS: The number of prophylactic bilateral mastectomies performed varied from 6 to 19. The mean age of women undergoing prophylactic mastectomy was 43.5 years. Eighty percent of the women had prophylactic mastectomy performed because of a family history of breast carcinoma (89 of 99) or because of a known BRCA1 or BRCA2 mutation (10 of 99). Twenty percent of the women had no family history, but had the surgery for other benign breast conditions. Women with a family history of breast carcinoma were much more likely to have a total mastectomy (89%) than a subcutaneous mastectomy (11%). Sixty percent of the women had reconstructive surgery following mastectomy. CONCLUSIONS: Prophylactic mastectomy is not performed on a large scale. The introduction of genetic testing for BRCA1 and BRCA2 has the potential to change the patterns of practice for prophylactic mastectomy.
Subject(s)
Breast Neoplasms/prevention & control , Mastectomy/statistics & numerical data , Adult , Aged , Breast Neoplasms/genetics , Female , Genes, BRCA1 , Genes, BRCA2 , Genetic Predisposition to Disease , Hospitals, Community/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Humans , Mastectomy, Simple/statistics & numerical data , Mastectomy, Subcutaneous/statistics & numerical data , Middle Aged , Ontario , Risk FactorsABSTRACT
OBJECTIVE: To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. DATA SOURCES: Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). STUDY DESIGN: Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). PRINCIPAL FINDINGS: In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. CONCLUSIONS: LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS.
Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Breast Neoplasms/surgery , Insurance Coverage/statistics & numerical data , Mastectomy/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Adult , Ambulatory Surgical Procedures/economics , Comorbidity , Cross-Sectional Studies , Female , Geography , Health Maintenance Organizations/economics , Health Services Research , Humans , Logistic Models , Longitudinal Studies , Mastectomy/economics , Mastectomy/methods , Mastectomy, Segmental/economics , Mastectomy, Segmental/statistics & numerical data , Mastectomy, Simple/economics , Mastectomy, Simple/statistics & numerical data , Medicare , Middle Aged , United States/epidemiology , Utilization ReviewABSTRACT
Introducción: Estudio de las pacientes portadoras de carcinoma de mama que aún son sometidas a mastectomías. Material y métodos: Se evalúan 3108 carcinomas de mama tratados entre abril de 1993 y diciembre de 1999, los que fueron agrupados según recibieron tratamientos radicales (1834) o tratamientos conservadores (1029). En los restantes 237 casos se realizaron otros procedimientos. La edad media fue de 55 años. El seguimiento medio fue de 42 meses (rango 1-365). Resultados: Con respecto al motivo de consulta, se observó un aumento de los carcinomas diagnosticados a raíz de un control habitual (p < 0,05), como así también un incremento significativo de los estadios 0 y I (p < 0,05). Estudiando la progresión en el tiempo de las distintas técnicas empleadas, se observó una paulatina disminución de las mastectomías y un incremento de las cirugías conservadoras. La mastectomía radical clásica de Halsted y la resección del músculo pectoral menor ya han caído en desuso. En los últimos 4 años, el 30 por ciento de pacientes requirieron una mastectomía debido fundamentalmente al tamaño tumoral, la multicentricidad, el componente intraductal extensivo y edad avanzada. De éste subgrupo de pacientes, en el 41 por ciento se realizó reconstrucción mamaria. Conclusiones: A pesar de los buenos resultados obtenidos con la cirugía conservadora, existe hoy en día un 30 por ciento de carcinomas mamarios que requieren una mastectomía para poder obtener un correcto control locorregional
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Breast Neoplasms , Mastectomy, Extended Radical/statistics & numerical data , Mastectomy, Simple/statistics & numerical data , Mastectomy, Modified Radical , Mastectomy, Radical , Mastectomy, Segmental , Evaluation of Results of Therapeutic Interventions , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
Introducción: Estudio de las pacientes portadoras de carcinoma de mama que aún son sometidas a mastectomías. Material y métodos: Se evalúan 3108 carcinomas de mama tratados entre abril de 1993 y diciembre de 1999, los que fueron agrupados según recibieron tratamientos radicales (1834) o tratamientos conservadores (1029). En los restantes 237 casos se realizaron otros procedimientos. La edad media fue de 55 años. El seguimiento medio fue de 42 meses (rango 1-365). Resultados: Con respecto al motivo de consulta, se observó un aumento de los carcinomas diagnosticados a raíz de un control habitual (p < 0,05), como así también un incremento significativo de los estadios 0 y I (p < 0,05). Estudiando la progresión en el tiempo de las distintas técnicas empleadas, se observó una paulatina disminución de las mastectomías y un incremento de las cirugías conservadoras. La mastectomía radical clásica de Halsted y la resección del músculo pectoral menor ya han caído en desuso. En los últimos 4 años, el 30 por ciento de pacientes requirieron una mastectomía debido fundamentalmente al tamaño tumoral, la multicentricidad, el componente intraductal extensivo y edad avanzada. De éste subgrupo de pacientes, en el 41 por ciento se realizó reconstrucción mamaria. Conclusiones: A pesar de los buenos resultados obtenidos con la cirugía conservadora, existe hoy en día un 30 por ciento de carcinomas mamarios que requieren una mastectomía para poder obtener un correcto control locorregional (AU)