Background:The study aims to evaluate the current state and tendencies in multiple primary breast cancer incidence, behavior, and treatment in Ukraine.Methods:A total of 2032 patients who received special treatment at the Department of Breast Tumors and Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 were included in the study. Among them, there were 195 patients with multiple primary malignant neoplasms: 54.9% patients with synchronous cancer and 45.1% patients with metachronous cancer. The average age of patients was 46.6 years, and the percentage of postmenopausal women was 63.1%. Among patients with synchronous cancer, there were 56.1% patients with only breast localizations and 43.9% with combination of breast and other localizations, and among patients with metachronous cancer, there were 46.6% patients with only breast localizations and 53.4% with combination of breast and other localizations. All the patients were evaluated in terms of aggressiveness of the disease, survival rates, as well as risk factors and treatment options.Results:A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chernobyl accident under the age of 30 years (P < .01). The clinical course of disease in patients with synchronous cancer is worse and prognostically unfavorable compared with metachronous cancer (P < .01). The course of the disease in patients who underwent mastectomy is worse compared with patients who underwent breast-conserving surgery (P < .01). Plastic and reconstructive surgery in patients with synchronous cancer was proven to be reasonable in terms of increase in survival (P < .01).Conclusions:The patients with multiple primary breast cancer should have attentive management and treatment. Multidisciplinary team should concern all the risk factors and provide the most sufficient option of management. This is crucial to continue research in this oncological area.

Aim: The aim of this study was to develop and implement the concept of fast-track surgery (FTS) for reconstructive breast surgery in patients with breast cancer (BC) to improve early and long-term results of treatment. Materials and methods: The study includes 749 patients with stage 1 to 3 BC. A total of 253 patients with BC got treatment according to FTS program and were included to the core group. Other 496 patients with BC (control group) were not included to the FTS program. Patients were treated from December 2010 to December 2014. All age groups were covered (18-70 years old). Results: There was a significant difference in the average length of hospital stay (LOS) which was 14.27 ± 7.00 days in the core group and 20.11 ± 7.70 days in the control group ( P < .001). In advanced BC cases in the core group, LOS was >8 days lower comparing with the control group on average. The LOS in patients who underwent adjuvant chemotherapy was 2.7 times lower in the FTS group comparing with the control group. Conclusions: The study results allow us to recommend the concept of FTS for implementation in broad medical practice for breast reconstructive surgery in patients with BC. The FTS program was shown to be effective in all types of breast surgery, including immediate oncoplastic and reconstructive surgeries. The gradual reduction of LOS increased the number of surgeries in our department by 75% from 2008 till 2018.

There should be paid a great attention to synchronous and metachronous breast cancer patients in order to find and provide the best options of their management. This is crucial to continue researches in this field of oncology.

No abstract

Recently, an increase in the incidence of multiple primary malignant neoplasms has been observed, specifically, when two or more unrelated tumors originate from different organs and appear in the body simultaneously or sequentially, one after another. During past few years, the interval between the first and second reproductive cancer diagnosis has decreased in 6 times – from 11 to just 2 years while probability of surviving the next 3 years after 8.5 years past initial diagnosis has decreased from 0.995 to 0.562. Using performed analysis, this paper provides details of survival modelling for women with breast cancer with the aim to find the most significant factors affecting the likelihood of survival not by chance alone. The data used for research were obtained from Ukrainian National Institute of Cancer covering 1981–2017 period. The modelling was performed using Cox regression with forward effect selection method and stay in p-value boundary equal to 0.15. The forward method firstly computes the adjusted chi-square statistics for each variable. Then, it examines the largest computed statistics and if particular one is significant, the corresponding variable is added to the model. Once the variable is entered, it is never removed from the model. 3 out of 4 factors that appeared to be significant according to forward selection method were confirmed as the significant ones by stepwise selection method. The results of modelling proved the possibility of prediction the survival using certain set of disease features and subjects’ characteristics. Testing of global hypothesis for Beta resulted in rejecting of null hypothesis (Beta = 0) in favor of the alternative one (Beta ≠ 0) thus it was confirmed that the models make sense and can be used to predict survival in women with breast cancer. According to obtained results, the most significant disease features and subjects characteristics appeared to be: type of multiple processes (synchronous or metachronous), presence of relapse and/or metastasis, type and combination of treatment, stage of disease. Cancer with synchronous processes is characterized by greater aggressiveness and it reduces survival by almost 13 times compared with cancer where metachronous processes take place. Even though chemotherapy significantly increases the survival rate of patients, it also impacts the probability of relapses and metastasis occurrence, which are 16 times more likely to occur if chemotherapy was a part of treatment. This gives grounds for assumption that it has an indirect effect on survival and hence needs to be analyzed considering its negative impact on the relapses and metastasis occurrence probability, which, in turn, reduces survival by 10 times. This fact, in our opinion, introduces the need for further in-depth analysis. The significant difference between survival rates in patients with the first and third stages of cancer has been proved – the chances to survive with the disease at the first stage are almost 12 times higher than with disease at the third stage. At the same time, the difference in the survival rates in women with the disease at the second and the third stages is not so big and it is only 1.6 times. The modern method of conducting surgery compared with the standard one appeared to be capable to reduce the risk of relapses and metastases by 2.6 times, while breast conservative surgery in multiple oncological processes – by 3 times compared with mastectomy, which allows to state that both factors have a positive effect on the survival probability and reduce the risk of mortality. Regarding subgroup models built for patients having synchronous process and patients with metachronous processes separately, an increase in the sample size is needed to assess assumed difference in factors affecting survival and to improve predictive abilities of models. This, in turn, requires additional studies during which the necessary amount of data can be collected.