A multidisciplinary team approach minimises prophylactic mastectomy rates

Leff, Daniel; Ho, Chih-Hsiang; Thomas, Harun; Daniels, Richard; Side, Lucy; Lambert, F; Knight, Julia A.; Griffiths, Mat; Banwell, Miles E; Aitken, Jane; Clayton, Gill; Dua, Sascha; Shaw, A.; Smith, Simon; Ramakrishnan, Venkat

doi:10.1016/j.ejso.2015.02.017

Cited by 23 publications

(16 citation statements)

References 45 publications

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“…Despite an 83% survival rate, it is estimated that between 25% and 60% of breast cancer survivors experience post-surgical persistent pain, associated with reduced quality of life and motor dysfunction [9]. Some patients with chronic pain show features that suggest central pain sensitization, a process characterized by a generalized hypersensitivity of the somatosensory system, defined as an amplification of the neural signal at the level of the central nervous system [25].…”

Section: Introductionmentioning

confidence: 99%

The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review

Giacalone¹,

Alessandria²,

Ruberti³

2019

Cureus

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Section: Introductionmentioning

confidence: 99%

The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review

Giacalone¹,

Alessandria²,

Ruberti³

2019

Cureus

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“…Finally, the UK financial reimbursement schedule fails to reflect the additional workload. In the National Health Service (NHS), the Health Resource Group (HRG) code for UM and ABR (HRG code = JA36Z, = £10,627, = $15,141), 36 , 37 which compares unfavorably to BM (HRG code = JA37Z, = £13,083, $18,639). 37 Ideally, additional resources required to reduce risk through CPM should be traded off against the longitudinal costs saved in eliminating surveillance, and indeed treating CLBC downstream.…”

Section: Discussionmentioning

confidence: 99%

Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations

et al. 2018

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IntroductionPatients with sporadic breast cancer (BC) have low contralateral breast cancer risk (CLBCR; approximately 0.7% per annum) and contralateral prophylactic mastectomy (CPM) offers no survival advantage. CPM with autologous reconstruction (AR) has major morbidity and resource implications.ObjectiveThe aim of this study was to review the impact of PREDICT survival estimates and lifetime CLBCR scores on decision making for CPM in patients with unilateral BC.MethodsOf n = 272 consecutive patients undergoing mastectomy and AR, 252 were included. Five- and 10-year survival was computed with the PREDICT(V2) online prognostication tool, using age and clinicopathological factors. Based on family history (FH) and tumor biology, CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated against CLBCR estimates to identify patients receiving CPM with ‘low’ CLBCR (< 30% lifetime risk) and poor prognosis (5-year survival < 80%). Patients with ‘high’ CLBCR receiving unilateral mastectomy (UM) were similarly identified (UK National Institute of Health and Care Excellence [NICE] criteria for CPM, ≥ 30% lifetime BC risk). Justifications motivating CPM were investigated.ResultsOf 252 patients, 215 had UM and 37 had bilateral mastectomy and AR. Only 23 (62%) patients receiving CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%) failed to undergo CPM despite high CLBCR and good prognosis. CPMs were performed, at the patient’s request, for no clear justification (n = 8), contralateral non-invasive disease, and/or FH (n = 5), FH alone (n = 4) and ipsilateral cancer recurrence-related anxiety (n = 3).ConclusionIn the absence of prospective risk estimates of CLBCR and prognosis, certain patients receive CPM and reconstruction despite modest CLBCR, yet a proportion of patients with good prognoses and substantial risk are not undergoing CPM.

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“…In single institution studies in the United States and Canada, a second evaluation of patients referred to a multidisciplinary tumour board led to changes in the recommendations for surgical management in 77 of 149 of patients studied (52%) [102], and management plans changed in 41% of cases presented, the majority due to new/clarified diagnostic information [103]. A UK study found that MDT meetings enable cross-speciality interrogation of requests for prophylactic mastectomy, minimise unnecessary surgery and restrict mastectomy to those likely to derive maximum benefit [104]. A global survey, completed by principal investigators from 39 countries participating in a phase III trial, showed that mandatory MDT working for breast cancer ranged from about two-thirds of centres in Eastern/Western Europe to only a quarter in South America and a third in Asia [105].…”

Section: Critical Mass/volume Requirements/mdt Workingmentioning

confidence: 99%