OP4 Incidence of invasive recurrence in DCIS >5cm treated with skin sparing or nipple sparing mastectomy: The Australian experience

Abstract

model of screening which is stratified according to an individuals' risk would appear logical and this idea has been considered internationally and in Australia for the last few years. How Australian women view this approach is largely unknown however this most acceptable in overseas studies. This study aimed to explore breast screening participants' views of the current program in Victoria, Australia, examine their openness to change and attitudes toward an individualised screening model. This work was designed to inform the development of a decision aid to facilitate women's decisions about participating in individualised screening. Methods A qualitative approach was taken using focus groups that were facilitated in community settings in Melbourne, Victoria. Women were recruited from a population-based breast screening cohort, who are without a personal breast cancer history, and were currently engaged in the public breast screening program offered in Victoria, Australia. Focus group discussion was facilitated following three main themes: 1) experience of breast screening; 2) breast cancer risk perception, and 3) views on individualised screening. Results A total of 52 women participated in one of 4 focus groups and were experienced with screening with 90% of participants having had more than 3 mammograms. They had strong, positive, emotional ties to breast screening in its current structure but were supportive, with some reservations, of the idea of individualised screening. There was good understanding about the factors contributing to personalised risk and a wide range of opinions about the inclusion of genetic testing with genetic testing being considered a foreign and evolving domain. ConclusionsIndividualised breast screening that takes account of risk factors such as mammographic density, lifestyle and genetic factors would be acceptable to a population of women who are invested in the current system. The communication and implementation of a new program would be critical to its acceptance and potential success. Reservations may be had regarding uptake of genetic testing, motivations behind the change and management of the women allocated to a lower risk category. BackgroundSkin sparing (SSM) and nipple sparing mastectomy (NSM) techniques have been critiqued for higher local recurrence rate (LRR) in patients with extensive DCIS, with rates of 5-11% reported. Reported predictors include younger age, high-grade, comedo necrosis present, and involved margins 1 . This study aimed to identify frequency and predictors of loco-regional recurrence for patients undergoing SSM or NSM for DCIS in our practice. Methods Data retrieved using BreastSurgANZ BQA from 2001 to 2018 for patients undergoing NSM or SSM for DCIS >5cm. Cases with microinvasion or previous invasive disease or synchronous contralateral cancer were excluded. Results 603 cases of DCIS treated including 78 tumour with size >5cm undergoing SSM/NSM. Mean follow-up was 74months, mean age 58, mean tumour size 77mm, high-grade in 55, micropapillary archi...