The Value of Ipsilateral Breast Tumor Recurrence as a Quality Indicator: Hospital Variation in the Netherlands

Loo, Margriet van der Heiden‐van der; Siesling, Sabine; Wouters, Michel W. J. M.; Dalen, Thijs van; Rutgers, E.J.T.; Peeters, P. H. M.

doi:10.1245/s10434-015-4626-9

Cited by 28 publications

(23 citation statements)

References 19 publications

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“…In addition, positive margin rates are higher. For example, in a recent trial concerning cavity shaving after breast-conserving surgery, a high positive margin rate of 34 % was observed [32]. Our study shows that with less stringent re-excision guidelines, good local control can also be achieved.…”

Section: Discussionsupporting

confidence: 50%

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Bosma

Leij

Werkhoven

et al. 2016

Breast Cancer Res Treat

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The purpose of this study was to study the impact of changes in clinical practice on outcome in patients treated with breast-conserving therapy (BCT) over a period of 28 years. Patients with early invasive breast cancer, who were treated with BCT at the Netherlands Cancer Institute between 1980 and 2008, were studied. Clinical characteristics, treatment and outcome were compared between groups (1980-1987; 1988-1998; 1999-2008). The main endpoint analyzed was ipsilateral breast tumor recurrence (IBTR). 8485 patients with a median follow-up of 9 years (IQR 6-14 years) were analyzed. The cumulative 5- and 10-year IBTR incidences were, respectively, 2 and 5 % for the whole cohort and 4 and 9 % in patients ≤40 years. Young age was a significant risk factor for IBTR in multivariable analysis. IBTR-free interval was better for patients who received a RT boost (HR 0.65) or systemic therapy (HR 0.52). In later years, patients less often received a boost and more often underwent adjuvant systemic treatment. 761 patients (9.0 %) underwent a re-excision; the tumor resection margins were tumor free for 85 %. In later years (1999-2008), 89 % of patients had a tumor-free margin. The margin status of invasive carcinoma did not influence IBTR, DM rate, or OS. Between 1980 and 2008, locoregional control after BCT remained stable with low IBTR rates, even in young patients. These good results were achieved under the policy of accepting close or focally positive margins, indicating this is a safe approach. The results of this study may help in lowering the re-excision rates, which are high in many centers.

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Section: Discussionsupporting

confidence: 50%

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Bosma

Leij

Werkhoven

et al. 2016

Breast Cancer Res Treat

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“…Besides the risk of LRR, also SP risk was taken into account. This is especially important with longer follow‐up, as after 5 years, the risk of SP exceeds that of LRR and also while local control is increasing over time because of enhancements in treatment . As lifetime mortality is taken as an end point, the model itself introduces no lead‐time bias (overestimating the benefit of early detection by advancing the diagnosis).…”

Section: Discussionmentioning

confidence: 99%

Risk‐based breast cancer follow‐up stratified by age

et al. 2018

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Although personalization of cancer care is recommended, current follow‐up after the curative treatment of breast cancer is consensus‐based and not differentiated for base‐line risk. Every patient receives annual follow‐up for 5 years without taking into account the individual risk of recurrence. The aim of this study was to introduce personalized follow‐up schemes by stratifying for age. Using data from the Netherlands Cancer Registry of 37 230 patients with early breast cancer between 2003 and 2006, the risk of recurrence was determined for four age groups (<50, 50‐59, 60‐69, >70). Follow‐up was modeled with a discrete‐time partially observable Markov decision process. The decision to test for recurrences was made two times per year. Recurrences could be detected by mammography as well as by self‐detection. For all age groups, it was optimal to have more intensive follow‐up around the peak in recurrence risk in the second year after diagnosis. For the first age group (<50) with the highest risk, a slightly more intensive follow‐up with one extra visit was proposed compared to the current guideline recommendation. The other age groups were recommended less visits: four for ages 50‐59, three for 60‐69, and three for ≥70. With this model for risk‐based follow‐up, clinicians can make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow‐up visits for women with very low risks. The model can easily be extended to take into account more risk factors and provide even more personalized follow‐up schedules.

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“…Breast conservation treatment (BCT) is now an accepted mode of therapy for mammary cancer, although mastectomy used to be the mainstay of surgical treatment in the past. While previously, it was thought that BCT offered similar survival outcomes when compared to mastectomy, a growing body of evidence now suggests that BCT may be associated with higher survival and local control rates . Increasing eligibility for BCT now becomes a priority.…”

Section: Introductionmentioning

confidence: 99%

Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma

Tan¹,

Ong

Amy³

et al. 2017

Breast J

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The sick lobe hypothesis provides the basis for a lobar approach in radiology, pathology, and surgical treatment of breast cancer. This approach aims to remove the tumor together with the surrounding field of genetic aberrations. Detailed preoperative lobar imaging that properly maps the disease and assesses its extent guides the parenchymal resection. Integration of our knowledge of breast anatomy and pathology with the results of preoperative radiological mapping is critical in assessing the eligibility of patients with multifocal and/or multicentric breast cancer for breast conservation treatment. Through an appropriately selected incision, a multisegment resection of the diseased lobe(s) is performed, which leaves the residual parenchyma in a formation that allows dovetailing of one part into the other, like the way pieces of a jigsaw puzzle fit together. Detailed pathologic analysis of the surgical specimen provides valuable feedback to the radiologist, establishes the completeness of surgical intervention, and generates predictive information for therapeutic decisions. Our approach is a step in continuous search for ideal tailored therapy to avoid under or over-treatment of breast cancer patients.

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The Value of Ipsilateral Breast Tumor Recurrence as a Quality Indicator: Hospital Variation in the Netherlands

Abstract: Our population-based findings show that IBTR rates in the Netherlands are low and have improved over time. The 5-year IBTR rate as an indicator for quality of care of individual hospitals is of limited value.

Cited by 28 publications

References 19 publications

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Risk‐based breast cancer follow‐up stratified by age

Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma

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