Background Breast cancer treatment is a multimodality treatment with different options for the individual patient, aiming to preserve the breast contour in the vast majority of the patients. Different treatment modalities can be used for this goal: primary breast conserving surgery (BCS), BCS after neoadjuvant therapy and immediate breast reconstruction after ablative surgery. Which treatment strategy is chosen may depend on patient preferences as well as patient age. The aim of the present analysis was to describe the rate of breast contour preserving procedures (BCPP) as related to patient age. Material and methods All invasive M0 breast cancer patients diagnosed and operated in the Netherlands between 2011 – September 2013 were selected from the national NABON Breast Cancer Audit. Primary BCS rates, BCS rates after neoadjuvant therapy, and rates of immediate reconstructions after ablative surgery were calculated for various age groups: <40, 40 to 50, 50 to 70 and ≥ 70 years. Results A total of 34.577 patients were identified. Sixty percent (20.583 patients) underwent BCS. Primary BCS rates increased with age: 47%, 60%, 69% in patients aged <40 years, 40 to 50 years and 50 to 70 years, respectively. In patients aged ≥70 the BCS rate was considerably lower (48%). Immediate reconstructions were performed in 16% of all mastectomy patients. An inverse relationship was observed with patient age; the rate of immediate reconstructions decreased from 38% in patients <40 years to 1% in patients ≥70 years of age. A similar decrease in neoadjuvant therapy was seen over the various age groups in patients treated with BCS from 21% to 4% in patients <40 and ≥70, respectively. The table shows different treatment modalities. After combining these outcomes the rate of breast contour preserving surgery was similar in patients aged <70 (62-73%). Table 1. Various treatment modalities for invasive breast cancer patients < 40 years40 – 50 years50 – 70 years≥ 70 yearsPrimary breast conserving surgery47%60%69%48%Breast conserving surgery and neoadjuvant therapy21%14%6%4%Immediate reconstruction with mastectomy38%29%16%1%Breast contour preserving surgery*62%68%73%48%* Proportion of patients with primary breast conserving surgery, breast conserving surgery after neoadjuvant treatment and immediate reconstruction combined with mastectomy. Conclusions Patient age affected both the BCS with or without neoadjuvant therapy and the percentage of immediate reconstructions after mastectomy. Overall, more similar percentages in preservation of the breast contour are achieved for various age groups compared to BCS alone. Therefore, combining different treatment modalities into breast contour preserving surgery provides a more complete overview of maintaining the breast contour related to various age groups than BCS alone. Citation Format: Annelotte C van Bommel, Marie-Jeanne T Baas-Vrancken Peeters, Marc A Mureau, Margriet van der Heiden - van der Loo, Carolien H Smorenburg, Thijs van Dalen. Breast contour preserving surgery; a matter of patient age? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-16-08.
Background The lifetime risk of developing breast cancer is 1 in 8 for women in the Netherlands. Breast cancer care in the Netherlands is of high quality, resulting in low 5-year local recurrence rates of 1.5% after breast conserving therapy and 2.7% after mastectomy. Although good endpoints of breast cancer treatment are obtained, it is expected that further improvement of care can be achieved since unexplained variation in a number of treatment aspects was found between hospitals in the Netherlands. Clinical audits provide an important tool for quality assessment. Worldwide, only a few nationwide clinical audits for breast cancer care are currently running. In the Netherlands, a nationwide multidisciplinary clinical audit started three years ago. Material and methods The multidisciplinary national NABON Breast Cancer Audit (NBCA) started collecting data of all Dutch hospitals in 2011, facilitated by Comprehensive Cancer Centre the Netherlands (IKNL) and Dutch Institute for Clinical Auditing (DICA). The NBCA has several purposes: nation-wide evaluation of quality parameters, evaluation of guideline adherence, and providing weekly updated feedback to participating institutions. Results All Dutch hospitals (n=92) participate by providing data regarding delivered breast cancer care resulting in a database of more than 42.000 breast cancer patients (5.745 DCIS and 36.396 invasive carcinomas) in three years time. Eighty-nine percent of invasive breast cancer patients were treated with primary surgery of which 62% (n=19.885) with breast conserving surgery. Within three years time, several quality assessments improved such as guideline compliance for pre- and postoperative multidisciplinary team meetings, percentage of patients starting surgery within five weeks (see table). The percentage of patients that were treated with preoperative systemic treatment (12%; 95% CI: 0 – 47%) and patients receiving an immediate reconstruction after ablative surgery (19%; 95% CI 0 – 73%) still remained low with a large variation between hospitals. At the conference, results will be substantiated by funnelplots. Other quality indicators will be presented as well. Table 1. Quality indicator results and their improvement over years.20112013Preoperative MDT81%96%Postoperative MDT90%98%Time to operation ≤5 weeks (immediate reconstruction after mastectomy excluded)80%85%Tumor positive margins invasive breast cancer (without PST)6.1%5.0%Tumor positive margins DCIS25%20%PST for invasive breast cancer10%12%Immediate reconstruction after ablative surgery for invasive breast cancer15%19%Immediate reconstruction after ablative surgery for DCIS39%44%MDT= Multi-disciplinary team meeting; PST= Primary Systemic Treatment; DCIS= Ductal Carcinoma In Situ Conclusions The continuous cycle of registration and providing feedback by clinical auditing provides a powerful tool for quality monitoring and improving breast cancer care. Improvements of monodisciplinairy surgical and pathological aspects of care have been reached in a relatively short time period. However, for more complicated multidisciplinary issues like the use of primary systemic treatment and immediate reconstruction, detailed analyses of the variation between hospitals is needed to further improve these aspects of breast cancer care. Citation Format: Annelotte C van Bommel, Marie-Jeanne T Baas-Vrancken Peeters, Margriet van der Heiden - van der Loo, Thijs van Dalen, Emiel J Rutgers, Michel W Wouters, Marc B Lobbes, Ruud M Pijnappel, Marc A Mureau, Pieter J Westenend, Bart de Vries, Carolien H Smorenburg, Agnes Jager, John H Maduro, Henk Struikmans, Carol Richel, Marga Schrieks, Maike Schepens, Sabine Siesling, Vivianne C Tjan-Heijnen. The NABON breast cancer audit; quality improvement in three years' time [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-18.
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