Background ACOSOG Z1031 demonstrated that neoadjuvant endocrine therapy (NET) increased breast conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor positive breast cancer. We evaluated national trends in NET use in relation to Z1031 trial conduct and the impact of NET on rates of BCS. Methods Using the National Cancer Data Base (NCDB), we identified all cT2-4c hormone receptor positive breast cancer patients age ≥50 from 2004–2012. Time intervals of pre-Z1031 (2004–2006), during-Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined. Adjusted analyses were performed using multivariable logistic regression. Results Of 77,272 patients, 2,294 (3.0%) received NET. Clinical T stage distribution was 66,885 (86.6%) cT2, 7,318 (9.5%) cT3, and 3,069 (4.0%) cT4a-c. There was a small but statistically significant increase in NET use from 2.7% pre-Z1031 to 3.2% post-Z1031; the adjusted OR for NET was 1.28 (95% CI: 1.13–1.45, p<0.001) for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage; in cT2 patients, it increased from 1.8% pre-Z1031 to 2.4% post-Z1031 (p<0.001); in cT3 patients from 6.3% pre-Z1031 to 7.4% post-Z1031 (p=0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4% vs 43.9%, p=0.02) with adjusted OR 1.60 (95% CI: 1.46–1.75, p<0.001). Conclusions NET use has increased slowly since Z1031, however overall use remains low. NET significantly increased rates of BCS in patients with hormone receptor positive clinical T2-4c breast cancer. Clinicians should consider NET use for patients with hormone receptor positive breast cancer interested in BCS.

Background Deleterious BRCA mutation carriers with breast cancer are at increased risk for additional breast cancer events. This study evaluated the impact that timing of identification of BRCA+ status has on surgical decision and outcome. Methods The authors reviewed all BRCA carriers at their institution whose breast cancer was diagnosed between January 1996 and June 2015. Patient surveys, medical records, and institutional databases were used to collect data. Differences in surgical choice were analyzed using the chi-square test, and rates of subsequent breast cancer events were estimated using the Kaplan–Meier method. Results The study investigated 173 BRCA carriers with breast cancer (100 BRCA1, 73 BRCA2). Of the women with known BRCA mutation before surgery and unilateral stages 0 to 3 breast cancer (n = 63), 12.7 % underwent lumpectomy, 4.8 % underwent unilateral mastectomy (UM), and 82.5 % underwent bilateral mastectomy (BM). These surgical choices differed significantly (p < 0.0001) from those of patients unaware of their mutation at the time of surgery (n = 93) (51.6 % had lumpectomy, 19.4 % had UM, 29 % had BM). Of the patients with BRCA mutation identified after surgery who underwent lumpectomy or UM, 36 (59 %) of 66 underwent delayed BM. The patients with BRCA+ known before diagnosis presented with significantly lower-stage disease (p = 0.02) at diagnosis (69 % stage 0 or 1) than those whose BRCA mutation was identified after cancer diagnosis (40 % stage 0 or 1). Conclusions The study findings showed that BRCA mutation status influences surgical decision. The rates of BM were higher for the patients with BRCA mutation known before surgery. Identification of BRCA mutation after surgery frequently leads to subsequent breast surgery. Genetic testing before surgery is important for patients at elevated risk for BRCA mutation.

No abstract

No abstract

Given the methods and limitations of the data analysis, the single and partial aortic crossclamp techniques result in similar rates of stroke during on-pump coronary artery bypass grafting.