Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 237
Filtrar
3.
Breast Cancer Res Treat ; 184(2): 637-647, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32803637

RESUMO

PURPOSE: The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. METHODS: An electronic survey was conducted with members of the Brazilian Society of Breast Cancer Specialists (SBM) between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to breast cancer subtype and oncoplastic surgery. RESULTS: The response rate was 34.4% (503/1462 specialists). Most of the respondents (324; 64.4%) lived in a state capital city, were board-certified as breast specialists (395; 78.5%) and either worked in an academic institute or one associated with breast cancer treatment (390; 77.5%). The best response rate was from the southeast of the country (240; 47.7%) followed by the northeast (128; 25.4%). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p < 0.001). The southeast of the country (p = 0.005) and the state capital cities (p < 0.001) were associated with changes at the beginning of the pandemic, while being female (p = 0.001) was associated with changes during the pandemic. For hormone receptor-positive tumors with the best prognosis (Ki-67 < 20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki-67 > 30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p < 0.00001). For tumors ≥ 1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2 + tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation. CONCLUSIONS: Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus , Mamoplastia , Mastectomia , Terapia Neoadjuvante , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Brasil , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Assistência à Saúde , Gerenciamento Clínico , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Masculino , Mastectomia Segmentar , Pessoa de Meia-Idade , Seleção de Pacientes , Pós-Menopausa , Pré-Menopausa , Mastectomia Profilática , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Sociedades Médicas , Inquéritos e Questionários , Carga Tumoral
4.
Surgery ; 168(5): 859-867, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32819721

RESUMO

BACKGROUND: Increasingly, women are undergoing contralateral prophylactic mastectomy for the treatment of unilateral breast cancer. The relationship between contralateral prophylactic mastectomy and breast reconstruction, postsurgical complications, additional breast-related procedures, and cost has not received the attention it deserves. METHODS: Data from the New York comprehensive, all-age, all-payer, Statewide Planning and Research Cooperative System were queried to identify patients undergoing unilateral mastectomy or contralateral prophylactic mastectomy from 2008 to 2010. We identified the complications and breast-related procedures within a 2-y follow-up period. Costs of the index operation and subsequent follow-up were estimated. Univariate and multivariate analyses were conducted. RESULTS: Of 12,959 women identified, 10.7% underwent contralateral prophylactic mastectomy. On univariate analysis, contralateral prophylactic mastectomy was positively associated with breast reconstruction, complications, and additional breast-related procedures. Rates of complications were greater for women who had contralateral prophylactic mastectomy (29.5% vs 20.8% for unilateral mastectomy group; P < .001), but not after stratifying by breast reconstruction. Additional breast-related procedures were more common in the contralateral prophylactic mastectomy group than in the unilateral mastectomy group, but only for those who underwent breast reconstruction (82.8% vs 72.1%; P < .001). Unadjusted costs were greater for women with contralateral prophylactic mastectomy than with unilateral mastectomy but did not differ between the groups after adjusting for breast reconstruction and additional breast-related procedures. CONCLUSION: Women who elected contralateral prophylactic mastectomy in this population-based study were more likely to have both breast reconstruction and additional breast-related procedures than women with unilateral mastectomy. The greater rates of complications and costs associated with contralateral prophylactic mastectomy were explained by breast reconstruction and additional breast-related procedures. Surgeons should counsel patients regarding the increased cost and likelihood of undergoing additional, non-complication-related procedures after contralateral prophylactic mastectomy with breast reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Custos de Cuidados de Saúde , Mamoplastia/economia , Mastectomia Profilática/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Seguro Saúde , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Mastectomia Profilática/efeitos adversos
5.
Plast Reconstr Surg ; 145(4): 865-876, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221191

RESUMO

BACKGROUND: Within the multidisciplinary management of breast cancer, variations exist in the reconstructive options offered and care provided. The authors evaluated plastic surgeon perspectives on important issues related to breast cancer management and reconstruction and provide some insight into factors that influence these perspectives. METHODS: Women diagnosed with early-stage breast cancer (stages 0 to II) between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries. These women were surveyed and identified their treating plastic surgeons. Surveys were sent to the identified plastic surgeons to collect data on specific reconstruction practices. RESULTS: Responses from 134 plastic surgeons (74.4 percent response rate) were received. Immediate reconstruction (79.7 percent) was the most common approach to timing, and expander/implant reconstruction (72.6 percent) was the most common technique reported. Nearly one-third of respondents (32.1 percent) reported that reimbursement influenced the proportion of autologous reconstructions performed. Most (82.8 percent) reported that discussions about contralateral prophylactic mastectomy were initiated by patients. Most surgeons (81.3 to 84.3 percent) felt that good symmetry is achieved with unilateral autologous reconstruction with contralateral symmetry procedures in patients with small or large breasts; a less pronounced majority (62.7 percent) favored unilateral implant reconstructions in patients with large breasts. In patients requiring postmastectomy radiation therapy, one-fourth of the surgeons (27.6 percent) reported that they seldom recommend delayed reconstruction, and 64.9 percent reported recommending immediate expander/implant reconstruction. CONCLUSIONS: Reconstructive practices in a modern cohort of plastic surgeons suggest that immediate and implant reconstructions are performed preferentially. Respondents perceived a number of factors, including surgeon training, time spent in the operating room, and insurance reimbursement, to negatively influence the performance of autologous reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/estatística & dados numéricos , Mastectomia/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Idoso , Implantes de Mama/estatística & dados numéricos , Feminino , Georgia , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Los Angeles , Mamoplastia/economia , Mamoplastia/instrumentação , Mamoplastia/métodos , Pessoa de Meia-Idade , Mastectomia Profilática/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Retalhos Cirúrgicos/economia , Retalhos Cirúrgicos/transplante , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento , Dispositivos para Expansão de Tecidos/estatística & dados numéricos
6.
Breast Cancer Res Treat ; 180(1): 177-185, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31894446

RESUMO

PURPOSE: Recent trends indicate increased use of contralateral prophylactic mastectomy (CPM) among newly diagnosed breast cancer patients, particularly those who test positive for a pathogenic variant in the BRCA1/2 genes. However, the rate of CPM among patients who test negative or choose not to be tested is surprisingly high. We aimed to identify patient predictors of CPM following breast cancer diagnosis among such patients. METHODS: As part of a randomized controlled trial of rapid genetic counseling and testing vs. usual care, breast cancer patients completed a baseline survey within 6 weeks of diagnosis and before definitive surgery. Analyses focused on patients who opted against testing (n = 136) or who received negative BRCA1/2 test results (n = 149). We used multivariable logistic regression to assess the associations between sociodemographic, clinical- and patient-reported factors with use of CPM. RESULTS: Among patients who were untested or who received negative test results, having discussed CPM with one's surgeon at the time of diagnosis predicted subsequent CPM. Patients who were not candidates for breast-conserving surgery and those with higher levels of cancer-specific intrusive thoughts were also more likely to obtain a CPM. CONCLUSION: The strongest predictors of CPM in this population were objective clinical factors and discussion with providers. However, baseline psychosocial factors were also independently related to the receipt of CPM. Thus, although CPM decisions are largely guided by relevant clinical factors, it is important to attend to psychosocial factors when counseling newly diagnosed breast cancer patients about treatment options.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Profilática , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Tomada de Decisão Clínica , Terapia Combinada , Gerenciamento Clínico , Feminino , Genes BRCA1 , Genes BRCA2 , Aconselhamento Genético , Predisposição Genética para Doença , Testes Genéticos , Humanos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estadiamento de Neoplasias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Acta Oncol ; 59(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31379231

RESUMO

Background: Preoperative genetic testing affects the surgical decision-making among women with breast cancer. To avoid breast-conserving surgery and to offer the possibility of mastectomy with immediate reconstruction in high-risk patients, genetic testing for pathogenic variants in BRCA1 or BRCA2 and a pedigree-based familial breast cancer risk assessment was offered to younger women with breast cancer in Denmark. We evaluated the impact of the risk stratification through genetic counseling on the uptake of contralateral prophylactic mastectomy (CPM).Material and methods: The prospective cohort study included all women with unilateral breast cancer before the age of 45 who participated in a genetic counseling program during their primary diagnostics in the Central Denmark Region (2013-2018). Each patient was followed from the time of the genetic test result to the end of follow-up to estimate the long-term uptake of CPM as a competing risk-adjusted cumulative incidence. We compared the uptake of CPM between the various genetic risk categories, ages of onset, and family histories in a multivariable Cox proportional hazards regression model, reporting hazard ratios (HR) with two-sided 95% confidence intervals (CIs).Results: 156 females, aged 21-44, learned their genetic test result within a median of 92 days [interquartile range (IQR): 75-114]. The maximal follow-up was 3.8 years (median 1.8; IQR: 0.49-2.5), after which 33% (95% CI: 24-42%) of the patients had undergone CPM. The uptake of CPM was inversely associated with the age of onset (HR 0.92; 95% CI: 0.86-0.98) and significantly higher among BRCA carriers (HR 2.9; 95% CI: 1.3-6.8) and patients from the high risk of breast cancer families (HR 5.6; 95% CI: 1.9-16) compared to the lower genetic risk categories.Conclusion: The risk stratification obtained through genetic counseling had a considerable impact on the surgical decision-making among younger women with breast cancer at long-term follow-up.


Assuntos
Proteína BRCA1/genética , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Aconselhamento Genético/métodos , Mutação , Mastectomia Profilática/psicologia , Adulto , Neoplasias da Mama/genética , Tomada de Decisões , Feminino , Aconselhamento Genético/psicologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudos Prospectivos , Adulto Jovem
8.
Am J Surg ; 219(6): 1036-1038, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31570198

RESUMO

BACKGROUND: Rates of contralateral prophylactic mastectomy (CPM) are increasing, and there are many resources available to help patients with decision-making. We sought to determine how often these were used, and whether their use influenced satisfaction with decision to pursue CPM. METHODS: CPM patients at a large academic institution were surveyed regarding factors associated with their CPM decision, and their satisfaction with the same. RESULTS: Of 58 CPM patients approached to participate, 55 completed the survey with a mean SWD score of 4.85 (range 3.00-5.00). Partner opinion (47.3%), family opinion (45.5%), other cancer patients' experiences (38.2%), and informational websites (38.2%) were the most frequently cited resources used by CPM patients. On multivariate analysis, controlling for other factors affecting SWD, use of other cancer patients' experiences predicted above average SWD (p = 0.049). CONCLUSION: Those who use other cancer patients' experiences to aid in their surgical decision-making enjoy a higher satisfaction with their decision.


Assuntos
Neoplasias da Mama/cirurgia , Tomada de Decisões , Satisfação do Paciente , Mastectomia Profilática/psicologia , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade
9.
Breast Cancer Res Treat ; 179(2): 255-265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605310

RESUMO

INTRODUCTION: There has been a sharp rise in the rate of contralateral prophylactic mastectomy over the last decade, despite the low incidence of new primary cancers predicted for the contralateral breast. This study compares the postoperative complication rates between the diseased breast treated with mastectomy and the contralateral breast that underwent prophylactic mastectomy, followed by immediate bilateral breast implant reconstruction. We hypothesized that there will be no difference in postoperative outcomes between prophylactic and diseased groups, as the surgical approach would be comparable. METHODS: After IRB approval, a retrospective chart review identified consecutive unilateral breast cancer patients who underwent bilateral mastectomy and immediate breast reconstruction between May 2008 and May 2018 at a tertiary academic medical center. A paired sample t-test and a penalized logic regression model were constructed to identify relationships between breast laterality and outcomes. RESULTS: A total of 1117 patients with unilateral breast cancer who underwent bilateral mastectomy and immediate breast implant reconstruction were identified. Rates of capsular contracture and infection were significantly greater in the diseased breast, while rates of revision were significantly greater in the contralateral prophylactic breast. There were no statistically significant differences between breasts in rates of explant, skin flap necrosis or hematoma. When adjusted for confounding variables, a higher infection rate was observed in the diseased breast. CONCLUSION: This study detected significant differences in postoperative complication rates between the diseased and prophylactic breasts following bilateral mastectomy and immediate breast implant reconstruction. Postoperative complications occurred more frequently in the diseased breast compared with low rates of complications in the contralateral prophylactic breast. This information is helpful for preoperative decision making, as surgeons and patients carefully weigh the additional risks of contralateral prophylactic procedure.


Assuntos
Implante Mamário/efeitos adversos , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Mastectomia Profilática/efeitos adversos , Adulto , Implante Mamário/métodos , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Terapia Combinada , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Mastectomia Profilática/métodos , Medição de Risco , Resultado do Tratamento
11.
Breast Cancer ; 27(1): 70-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31292927

RESUMO

BACKGROUND: Breast reconstruction is a favorable option for women with BRCA1 or BRCA2 mutations (BRCA1/2Mut+) who undergo risk-reducing mastectomy (RRM). We assessed characteristics of patients who underwent RRM, with or without breast reconstruction. METHODS: We included 46 patients with BRCA1/2Mut+ who underwent RRM from July 2011 to December 2017. RESULTS: Among the 46 patients who underwent RRM, 3 had not been diagnosed with breast cancer (BC) and 43 had cancer in a single breast; 33 patients (71.7%) underwent breast reconstruction with RRM; and 13 patients (28.3%) did not undergo breast reconstruction. All of 3 patients who had not been diagnosed with BC underwent bilateral RRM with breast reconstruction. There was no significant difference of clinical characteristic between patients undergoing RRM with and without breast reconstruction. However, patients who decided to undergo RRM with the current diagnosis of BC had significantly higher rates of RRM with breast reconstruction than that of patients with a past history of BC (P = 0.043). The rate of nipple-sparing mastectomy (NSM) in patients with breast reconstruction was significantly higher (28 of the 37 breasts, 75.7%) than that in patients without reconstruction (3 of the 14 breasts, 21.4%) (P < 0.001). Two patients who had complications underwent RRM with breast reconstruction, and one of them had a history of irradiation after lumpectomy. CONCLUSIONS: For BRCA1/2Mut+ patients, the decision of taking RRM with the diagnosis of current BC might affect whether they undergo immediate breast reconstruction with RRM. These patients who undergo RRM with breast reconstruction preferred NSM to skin-sparing mastectomies.


Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia Profilática , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Mutação , Mastectomia Profilática/métodos , Mastectomia Profilática/estatística & dados numéricos
12.
J Womens Health (Larchmt) ; 29(2): 220-229, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30759049

RESUMO

Background: Contralateral prophylactic mastectomy (CPM) treatments have been on the rise among white women with early stage unilateral breast cancer who have a higher socioeconomic status (SES) and private insurance. Low income and uninsured women are not choosing CPM at the same rate. The purpose of this study was to evaluate the socioeconomic factors related to the choice of surgical treatment in women diagnosed with unilateral breast cancer in the state of New Jersey. Materials and Methods: This retrospective study of 10 years of breast cancer data abstracted from the New Jersey State Cancer Registry utilized bivariate analyses and two multivariate logistic regression models to analyze the effect of socioeconomics on choice of surgical treatment. Results: In New Jersey, 52,529 women were treated for breast cancer from 2004 to 2014. CPM rates increased gradually over time from 3.72% in 2004 to 10.82% in 2014 with women more likely to choose CPM if they were younger, white, and had private insurance (p < 0.001). The single factor that was most predictive of choosing CPM was access to immediate reconstruction (odds ratio 2.36, confidence interval 2.160-2.551). Women with low SES were much less likely to choose CPM. Conclusions: Results of this study may provide incentive for researchers to assess the impact of culture, race/ethnicity, and socioeconomics on a woman's interactions with health care providers so as to allow all women regardless of SES to express their needs, concerns, and wishes when confronted with a breast cancer diagnosis.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Profilática/economia , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Humanos , Modelos Logísticos , Mastectomia , Pessoa de Meia-Idade , New Jersey , Estudos Retrospectivos
13.
Eur J Surg Oncol ; 46(4 Pt A): 511-515, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31706716

RESUMO

PURPOSE: Acellular dermal matrices (ADM) are increasingly used in implant-based breast reconstruction (IBR). Uncertainty remains with regard to their efficacy and complications. The aim of this study was to evaluate the outcomes and complication rates associated with the use of ADMs in IBR. METHODS: Retrospective cohort study of patients undergoing ADM-assisted IBR between 2008 and 2013. Cases were identified from a prospectively collected database. Simple descriptive statistics and logistic regression analysis were performed. RESULTS: A total of 110 patients (175 mastectomies) were included in the analysis. The median age was 46 (19-75) years and the median BMI was 22.2 (16.2-41.5). Seventy nine mastectomies were performed for therapeutic purposes. The median mastectomy weight was 244 (185-335) gr. The majority of reconstructions were performed with fixed volume (n = 115, 66%) or permanent expandable implants (n = 53, 30%) as one-stage procedures. Forty mastectomies were associated with at least one complication. The infection rate was 2.3% (n = 4). Post-operative haematoma developed in 5 cases (2.9%), but only 2 required surgical interventions. Three mastectomies were complicated by nipple necrosis (3.6%), 3 with skin necrosis (1.7%) and 9 with wound dehiscence (5.1%). The capsule formation rate was 2.3% (n = 4). Reconstruction failure with implant loss occurred in 3 cases (1.7%). CONCLUSIONS: The complication rates following ADM-assisted IBR can be very low with appropriate patient selection and meticulous surgical technique. This supports the safety of using ADM in carefully selected patients. Further research is warranted to assess the health economics of ADM use in IBR.


Assuntos
Derme Acelular , Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/cirurgia , Mastectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Neoplasias da Mama/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Contratura Capsular em Implantes/epidemiologia , Tempo de Internação , Excisão de Linfonodo , Mamoplastia , Pessoa de Meia-Idade , Necrose , Mamilos , Tratamentos com Preservação do Órgão , Complicações Pós-Operatórias/terapia , Mastectomia Profilática/métodos , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Seroma/epidemiologia , Seroma/terapia , Pele , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/terapia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/terapia , Falha de Tratamento , Adulto Jovem
14.
Ann Surg Oncol ; 27(3): 743-749, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31732944

RESUMO

BACKGROUND: Neoadjuvant chemotherapy (NAC) for breast cancer increases breast-conserving surgery (BCS) rates, but many women opt for mastectomy with contralateral prophylactic mastectomy (CPM). Here we evaluate factors associated with CPM use in women undergoing mastectomy post-NAC. METHODS: A retrospective institutional NAC database review identified women with clinical stage I-III, unilateral invasive breast cancer undergoing unilateral mastectomy (UM) or CPM mastectomy from 9/2013 to 12/2017. Clinical/pathologic characteristics, imaging, and presence of contraindications to BCS post-NAC were compared, with subset analysis of BCS candidates. The multivariable analysis was adjusted for potential confounders. RESULTS: Five hundred sixty-nine women underwent mastectomy after NAC, 297 (52%) UM and 272 (48%) CPM. On univariable analysis, younger age, BRCA+, lower pre-NAC clinical stage, pathologic complete response, and axillary surgery extent were associated with CPM (all p < 0.01). Favorable post-NAC clinical factors of no residual palpable disease, clinically negative nodes, complete response on breast imaging, and no post-NAC contraindication to BCS were also associated with CPM (all p < 0.01). On multivariable analysis, young age (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91-0.95), lower pre-NAC stage (OR 0.51, 95% CI 0.34-0.77), and no contraindication to BCS (OR 3.12, 95% CI 2.02-4.82) were significantly associated with CPM. Among the 203 (35%) women who had no contraindications to BCS post-NAC, 145 (71%) underwent CPM. BRCA+ and family history were reasons more frequently cited for mastectomy among CPM than UM (p < 0.001). CONCLUSIONS: CPM was performed in 48% of women undergoing mastectomy after NAC; younger women with earlier-stage cancers were more likely to undergo CPM. While increased use of CPM in women with more favorable disease is medically appropriate, our findings indicate a lost opportunity for use of BCS.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/cirurgia , Terapia Neoadjuvante/métodos , Mastectomia Profilática/métodos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
16.
Am J Case Rep ; 20: 1812-1816, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31801936

RESUMO

BACKGROUND Technical innovations allow endoscopic nipple-sparing mastectomy (NSM), which is well tolerated and associated with greater patient satisfaction. Endoscopic technique did not have wide diffusion; many centers have abandoned this technique because of technical challenges. Implant-based reconstruction (IBR) remains the most common form of breast reconstruction. Current techniques involve partial or total coverage of the implant with pectoralis major muscle to prevent exposure or infection. Muscle dissection has functional and cosmetic consequences. CASE REPORT We present a case of 45-year-old patient presenting with personal history of right breast cancer. The patient requested left prophylactic mastectomy. We used a 4 cm-long single hidden scar on axillary line. Endoscopic nipple-sparing mastectomy was done using a single port with 3 sleeves. Immediate breast reconstruction was performed by inserting a silicon implant in prepectoral plane without Acellular Dermal Matrix (ADM). At 6 months postoperatively, no complication had been reported. The patient was satisfied with the result and no further correction was necessary. CONCLUSIONS Endoscopic surgery is a valuable option for nipple-sparing mastectomy. This method is a less expensive alternative technique to robotic approach. It could enable safe prepectoral IBR without placement of ADM and with lower risk of complications.


Assuntos
Implantes de Mama , Endoscopia , Mamoplastia , Mamilos/cirurgia , Mastectomia Profilática/métodos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão
17.
Breast ; 48 Suppl 1: S62-S64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31839163

RESUMO

In the past decades the demand for prophylactic mastectomies has increased substantially. For healthy non high risk germ line mutation carriers there is no real objective justification for such a procedure, and screening according established evidence based guidelines is strongly advised. More demand for contralateral prophylactic mastectomy is coming from women diagnosed with breast cancer. First counseling and appropriate germ line gene mutation testing has to be established. In absence of high risk mutations, breast conservation therapy for the diagnosed breast cancer is as good as mastectomy, and the risk of a contralateral breast cancer is low (0.3-0.6% per annum follow up). So bilateral mastectomy will not provide any survival benefit and is associated with worsened body image and QoL, and more complications and re-operations as compared to breast conservation followed by screening. The patient asking for a CPM deserves careful counseling and a shared decision process.


Assuntos
Neoplasias da Mama/prevenção & controle , Segunda Neoplasia Primária/prevenção & controle , Seleção de Pacientes , Mastectomia Profilática/psicologia , Tomada de Decisão Compartilhada , Feminino , Humanos
20.
Presse Med ; 48(10): 1092-1100, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31706893

RESUMO

In France, breast cancer is the most common cancer among women and the leading cause of cancer deaths. Identifying women with a "high" or "very high" breast cancer risk, according the terminology of the Haute Autorité de Santé 2014 guidelines, is essential to offer them special cares in term of screening and prevention. Women genetically predisposed have a very high risk of breast cancer. During the oncogenetic specialist consultation, familial and personal history of cancer is taken into account to evaluate the risk of hereditary Breast/Ovarian syndrome and thus the need of a genetic screening. In 2017, a list of 13 genes involved in hereditary ovarian or breast cancer has been established in France (Genetic and Cancer Group - Unicancer). Women carrying a BRCA1, BRCA2, PALB2, TP53, CDH1, PTEN mutation have a higher risk of breast cancer and are considered as "high risk". Therefore, medical breast surveillance similar to carriers of BRCA1/BRCA2 mutation is recommended for these patients (INCa guidelines 2017). However a mutation in one of those genes is only identified in approximatively 10 % of the screened families. The oncogenetic specialist's assessment distinguishes families in which women remain at a "high" risk of breast cancer (HAS 2014 for screening) from those where women have a "very high" risk (INCa guidelines 2017 for screening and prevention).


Assuntos
Neoplasias da Mama/genética , Predisposição Genética para Doença , Mutação , Fatores Etários , Antígenos CD/genética , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Neoplasias da Mama Masculina/genética , Caderinas/genética , Saúde da Família , Proteína do Grupo de Complementação N da Anemia de Fanconi/genética , Feminino , França , Genes BRCA1 , Genes BRCA2 , Genes p53 , Testes Genéticos , Síndrome do Hamartoma Múltiplo/genética , Humanos , Síndrome de Li-Fraumeni/genética , Masculino , Neoplasias Ovarianas/genética , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Gravidez , Mastectomia Profilática , Fatores de Risco , Nanomedicina Teranóstica , Neoplasias de Mama Triplo Negativas/genética
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...