Tag: mastectomy

Categories : CancerTags :

When Should Preventive Mastectomy be Offered in High Breast Cancer Risk?

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Photo by National Cancer Institute on Unsplash

More women at higher risk of breast cancer should be offered a mastectomy, according to researchers at Queen Mary and London School of Hygiene and Tropical Medicine.

A new analysis, published in JAMA Oncology, has found that the surgical technique was a cost-effective way of reducing the likelihood of developing breast cancer compared to breast screening and medication. Current guidelines on who is offered mastectomy may need to be revised to reflect these new findings. 

Clinicians currently use personalised risk prediction models which combine genetic and other data to identify those women who are at a higher risk of developing breast cancer (BC). Subsequent treatment options – including mammograms, MRI screening, surgery, and medication – are then offered dependent on each woman’s level of risk. 

Risk reducing mastectomy (RRM) is recommended for women at high risk, but in practice this surgery is only clinically offered to those carrying faults (called pathogenic variants) in genes that are known to increase the likelihood they will develop the disease (BRCA1/ BRCA2/ PALB2 PV). 

Professor Ranjit Manchanda from Queen Mary University of London, Dr Rosa Legood from London School of Hygiene and Tropical Medicine, along with colleagues from Manchester University and Peking University created a new economic evaluation model to accurately predict the level of risk that would make RRM a more cost-effective treatment. 

For their model, researchers used guidelines from the National Institute for Health and Care Excellence (NICE) to determine whether a treatment is considered cost-effective. Their model showed that mastectomy was a cost-effective treatment for women aged 30 or above who have a lifetime breast cancer risk greater than or equal to 35%. Offering RRM to women in this cohort could potentially prevent 6,500 of the 58,500 cases of breast cancer that are diagnosed every year in the UK. 

Professor Manchanda, Professor of Gynaecological Oncology at Queen Mary and  Consultant Gynaecological Oncologist, said: “We for the first time define the risk at which we should offer RRM. Our results could have significant clinical implications to expand access to mastectomy beyond those patients with known genetic susceptibility in high penetrance genes- BRCA1/ BRCA2/ PALB2 – who are traditionally offered this. This could potentially prevent can potentially prevent ~6500 breast cancer cases annually in UK women. We recommend that more research is carried out to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group”.. 

Dr Legood, Associate Professor in health economics at the London School of Hygiene & Tropical Medicine, said: “Undergoing RRM is cost-effective for women 30-55 years with a lifetime breast cancer risk of 35% or more. These results can support additional management options for personalized breast cancer risk prediction enabling more women at increased risk to access prevention.”  

Dr Vineeth Rajkumar, Head of Research at Rosetrees, said: “Rosetrees is delighted to fund this truly groundbreaking research that could have a positive impact on women worldwide.” 

The researchers used data from women aged between 30 and 60 with varying lifetime breast cancer risks between 17% and 50%, and who were either undergoing RRM or receiving screening with medical prevention according to currently used predictive models. 

NICE deems a treatment cost-effective if it typically brings one additional year of health for no more than £20 000–£30 000 per patient (known as the ‘willingness to pay’ threshold, or WTP). The researchers’ model used a threshold of £30 000/Quality Adjusted Life Year. 

Source: Queen Mary University London

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Changing Order of Breast Cancer Treatments Could Improve Outcomes

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Changing the order of treatments given to breast cancer patients could reduce side effects resulting from mastectomy and improve outcomes, according to a clinical feasibility trial, published in The Lancet Oncology.

In the study, researchers found that switching the sequence of treatments given to breast cancer patients was safe, without any increase in complications and could lead to patients receiving faster and more effective care compared to current methods.

Thirty-three women with breast cancer requiring a mastectomy and post-mastectomy radiotherapy, were recruited to the primary radiotherapy and deep inferior epigastric perforator flap reconstruction for patients with breast cancer (PRADA) trial between January 2016 and December 2017.  They were also eligible for a breast reconstruction using tissue from another part of their body.

They were given chemotherapy followed by radiotherapy before having a mastectomy and a breast reconstruction. The team found that this approach was feasible and safe.  They also found that side effects were low and that 12 months after surgery patients reported high levels of satisfaction with their breast reconstruction.

Lead author Daniel Leff said: “We believe that, in the long term, this approach will improve patients’ mental and physical wellbeing with higher quality of life scores and satisfaction with their reconstructed breasts compared to current care. It also means that many patients who are currently denied reconstruction due to concerns of further complications due to radiotherapy may be able to get access to this treatment in future.”

Source: Imperial College London

Categories : Cancer HospitalsTags :

Key Factors in Hospitalisation after Breast Reconstruction Surgery

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Factors such as anaemia and anticoagulants have more impact on hospitalisation time after breast reconstruction than “common” risk factors according to a new study published in the Journal of Clinical Medicine.

The study investigated the impact of different factors on postoperative blood loss and drainage fluid volume, two factors which can lengthen hospitalisation time of patients after breast reconstruction after breast cancer surgery. The findings of the study allow for an improved risk assessment and planning of reconstructive breast surgery to offer patients personalised and improved treatment.

Partial or total mastectomy is often necessary in breast cancer surgery, and reconstructive breast surgery lessens the psychological stress on the patient. Fast wound healing after surgical breast reconstruction is crucial to not delay subsequent cancer treatments. Factors influencing the length of hospital stay (LOS) or wound healing are therefore particularly significant in cancer treatment. This study identified previously unrecognised risk factors.

Blood loss and drainage fluid volumes after breast reconstruction due to breast cancer were recorded, parameters which are closely linked to the healing process and LOS .Lower loss equals earlier patient discharge and early start of subsequent treatment. “We analysed factors that might affect blood loss and drainage fluid volumes after surgery – but can be identified before the surgery,” explained lead author Dr Tonatiuh Flores, plastic surgeon. “These factors included age, body mass index and smoking status – factors that are known to have a strong impact on the course of disease.” Additionally, haemoglobin levels and possible antithrombotic prophylaxis were reviewed – two parameters that are particularly significant in oncological treatment.

Surprising results emerged from the evaluation of a total of 257 breast reconstructions in 195 patients. Professor Konstantin Bergmeister, senior author of the study explained that “the classic risk factors did not significantly influence postoperative blood loss and drainage fluid output. Haemoglobin levels and anticoagulant concentration, however, did.” The analysis revealed a close relation between low haemoglobin values or anaemia and fluid loss after reconstructive breast surgery. Co-author Prof. Klaus Schroegendorfer, elaborated on this: “Especially breast cancer patients often show perioperative anaemia, caused by the frequently required neoadjuvant chemotherapy which can affect blood values, in particular haemoglobin.”

There were similar findings regarding low molecular heparin used in cancer patients as antithrombotic prophylaxis. Patients receiving heparin tended to have increased drainage fluid output after surgery, though the effect was not as strong as with perioperative anaemia.

The study authors recommend that, to cut LOS and continue the necessary cancer treatment after reconstructive breast surgery in cancer patients as early as possible, patients should preoperatively be screened for anaemia and administration of low molecular heparin should be adapted to the patients’ risk. In correlation to the results, follow-up treatment can be improved, patients can be discharged earlier and cancer treatment can be continued.

Source: Karl Landsteiner University of Health Sciences

Categories : CancerTags :

Mastectomies Significantly Impact Quality of Life in Young Women

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Many young women with breast cancer choose mastectomies but afterwards experience a persistent decline in their sexual and psychosocial well-being, according to new research reported in JAMA Surgery.

In surveys conducted after patients underwent breast cancer surgery, significant quality of life (QoL) impacts were seen with mastectomies, with a greater extent of surgery worsening the QoL outcomes. The findings are important in light of recent trends towards younger women with breast cancer opting for bilateral mastectomies for unilateral breast cancer when breast conserving surgery was also an option.

“Historically, it was felt that 75 percent of breast cancer patients should be eligible for breast conserving surgery. Over time, however, more women, particularly young women, are electing to have a mastectomy,” said study lead author Laura Dominici, MD, a surgeon at Dana-Farber Brigham Cancer Center. “They frequently offer peace of mind as the reason for their decision – even though research shows that unless a woman has a genetic predisposition to breast cancer, she has a very low risk of developing cancer in the healthy breast.”

In this study, 560 participants, 40 and younger with breast cancer, filled in a patient reported outcomes survey known as BREAST-Q, an average 5.8 years after diagnosis.

Compared to those who had breast-sparing surgery, patients who had a mastectomy scored significantly lower in three QoL measures – satisfaction with the appearance of their breasts, psychosocial well-being, and sexual well-being. The results were consistent regardless of whether one or both breasts were removed, and that most had breast reconstruction surgery.

  • For breast satisfaction, patients who had breast-conserving surgery had an average BREAST-Q score of 65.5, compared with 54.6 in the bilateral mastectomy group.
  • For psychosocial well-being,  patients who had breast-conserving surgery had an average BREAST-Q score of 75.9, compared with 65.1 in the bilateral mastectomy group.
  • For sexual well-being, patients who had breast-conserving surgery had an average BREAST-Q score of 57.4, compared with 53.4 for the unilateral mastectomy group and 46.2 for the bilateral mastectomy group.

A fourth area examined by the survey, physical function, showed no difference between the groups. Women with financial challenges tended to have lower scores in all four categories.

“The decision of whether to have a mastectomy or breast-conserving surgery should be a shared decision between patients and their doctors,” Dr Dominici added. “Particularly when talking to young women, who are likely to have a long period of survivorship, it’s important that we as clinicians discuss the potential impacts of mastectomy on their quality of life. As our study indicates, those impacts are not insignificant and persist years into the future.”

The study’s main limitation is that it was not randomised, and quality of life was only evaluated at a single time point. Dr Dominici added there was no information about women’s quality of life prior to the study, which could have infuenced their decision making and their quality of life after surgery.

Source: Dana-Farber Cancer Institute