A Danish Randomized Trial Comparing Breast-Preserving Therapy with Mastectomy in Mammary Carcinoma: Preliminary results

Blichert-Toft, M; Brincker, H; Andersen, Jesper; Andersen, Knud West; Axelsson, C. K.; Mouridsen, H.T.; Dombernowsky, P; Overgaard, Marie; Gadeberg, C.; Knudsen, Gun Peggy; Borgeskov, S; Bertelsen, S; Knudsen, Jørgen Lindskov; Hansen, Jørn Bindslev; Poulsen, P. Ejby; Willumsen, H; Schousen, Peer; Froberg, Debra G.; Ørnsholt, J.; Andersen, M.; Olesen, Søren Schou; Skovgaard, S; Oster, Martin W.; Schumacher, H. R.; Lynderup, E. K.; Holm, Caroline

doi:10.3109/02841868809091767

Cited by 107 publications

(59 citation statements)

References 14 publications

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“…Strong randomized trial evidence on equivalent survival following mastectomy versus breast conserving therapy has been available since the 1980s [36][37][38]. The 1990 NIH consensus statement on treatment of early stage breast carcinoma recommended BCT [39] and confirmed the wisdom of the recommendation through emergent evidence [40][41][42].…”

Section: Mastectomy Versus Breast-conserving Therapy (Bct)mentioning

confidence: 99%

Breast cancer disparities and decision-making among U.S. women

Polacek

Ramos

Ferrer

2007

Patient Education and Counseling

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Objective: The impact of breast cancer is immense for all women, but the literature reveals an even greater impact on women of color and among socially and economically disadvantaged populations. Persistent differences in incidence and outcome are undoubtedly due to multiple factors, but one element in poor outcome may be treatment choice. Those treatments shown to be related to best outcomes are less likely to be chosen by certain groups of women. The effects of economic and cultural factors on breast cancer treatment choice have not been thoroughly explored; these factors must be understood if health care professionals are to intervene effectively to address disparities and improve breast cancer outcomes for all women. Methods: A review of the breast cancer literature was conducted in order to: (1) describe breast cancer disparities in the United States; (2) delineate factors that might contribute to those disparities; (3) assess possible mitigating factors for predominant causes; (4) begin to decide how health care interventions might allay the factors that contribute to disparities in breast cancer incidence and mortality. Results: Breast cancer incidence and outcome disparities in the United States are due to multiple interacting factors. These include information about treatment, different types of treatment, the emotional context of decision-making, and patient preference for level of involvement. Treatment decision-making is complex. Conclusion: Health literacy and level of decision-making involvement, both embedded in social and economic reality, are key components in breast cancer treatment decision-making and may contribute to breast cancer disparities in the United States. Current models of shared decision-making may not be generalizable to all breast cancer patients. Practice implications: Optimal breast cancer outcomes for all women depend on culturally and ethnically appropriate professional support. #

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Section: Mastectomy Versus Breast-conserving Therapy (Bct)mentioning

confidence: 99%

Breast cancer disparities and decision-making among U.S. women

Polacek

Ramos

Ferrer

2007

Patient Education and Counseling

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“…In Denmark the Danish Breast Cancer Group (DBCG) launched the DBCG 82 TM trial. This trial randomized early stage breast cancer patients to BCT or mastectomy in the period of 1982 to 1989 [7][8][9], and the results from the study demonstrated no differences in first failures and survival between the two treatment groups [8,9]. Thus, both nationally and internationally, BCT was found to be a safe procedure and has consequently been implemented into Danish guidelines as a routine procedure since 1989.…”

mentioning

confidence: 99%

Failure pattern and survival after breast conserving therapy. Long-term results of the Danish Breast Cancer Group (DBCG) 89 TM cohort

et al. 2016

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“…The essential purpose of BCS is to completely remove the cancer while maintaining the cosmetic appearance of the breast, which is important to the patients. Previous studies have reported that BCS followed by radiation had a similar outcome to that of mastectomy in terms of mortality rate (1)(2)(3)(4)(5). However, a positive margin and young age (<53-55) are significant risk factors for ipsilateral breast tumor recurrence (IBTR) (6)(7)(8).…”

Section: Introductionmentioning

confidence: 98%

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

Hisada

Sawaki

Ishiguro

et al. 2016

Molecular and Clinical Oncology

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Abstract.A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required. IntroductionThe standard surgical treatments for breast cancer are breast-conserving surgery (BCS) and mastectomy. The essential purpose of BCS is to completely remove the cancer while maintaining the cosmetic appearance of the breast, which is important to the patients. Previous studies have reported that BCS followed by radiation had a similar outcome to that of mastectomy in terms of mortality rate (1-5). However, a positive margin and young age (<53-55) are significant risk factors for ipsilateral breast tumor recurrence (IBTR) (6-8). Moreover, a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group showed that local recurrence affected survival rate (9). Recently, Moran et al (10) reported that the American Society of Radiation Oncology consensus guideline uses the results of a meta-analysis of margin width and IBTR. This guideline also indicated the optimal criteria for determining margin width in BCS. However, despite numerous previous studies, the criteria for intraoperative margin assessment in BCS have yet to be established. At our institution, intraoperative specimen digital mammography (SMMG) is used to assess the resection margins in all cases of BCS. The aim of the present study was to evaluate the usefulness of SMMG for achieving margin-free resection of breast tumors. Patients and methods Patients.A retrospective study of the medical records, pathological diagnosis and re-evaluation by SMMG of 426 breast cancer patients who underwent BCS at the Aichi Cancer Center Hospital (Nagoya, Japan) between J...

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A Danish Randomized Trial Comparing Breast-Preserving Therapy with Mastectomy in Mammary Carcinoma: Preliminary results

Cited by 107 publications

References 14 publications

Breast cancer disparities and decision-making among U.S. women

Breast cancer disparities and decision-making among U.S. women

Failure pattern and survival after breast conserving therapy. Long-term results of the Danish Breast Cancer Group (DBCG) 89 TM cohort

Impact of intraoperative specimen mammography on margins in breast-conserving surgery

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