Michael M Jonczyk1,2, Jolie Jean3, Roger Graham4, Abhishek Chatterjee5. 1. Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA, 02111, USA. mjonczyk@tuftsmedicalcenter.org. 2. Clinical Translational Science Program, Tufts University Sackler Graduate School, 136 Harrison Ave #813, Boston, MA, 02111, USA. mjonczyk@tuftsmedicalcenter.org. 3. Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA. 4. Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA, 02111, USA. 5. Department of Plastic Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA, 02111, USA.
Abstract
PURPOSE: Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). METHODS: A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson's chi-squared test for demographics, linear regression, and a non-parametric Mann- Kendall test to assess a temporal trend. RESULTS: The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3-46.1% (p = 0.21), M 35.8-26.4% (p = 0.001), M+R 15.9-23.0% (p = 0.03), and OS 1.8-4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96-91%) with an increased use of OS (4-9%). For the patient cohort undergoing mastectomy, M alone decreased (69-53%); M+R with muscular flap decreased (9-2%); and M+R with implant placement increased (20-40%)-all three trends p < 0.0001. CONCLUSION: The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.
PURPOSE:Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). METHODS: A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson's chi-squared test for demographics, linear regression, and a non-parametric Mann- Kendall test to assess a temporal trend. RESULTS: The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3-46.1% (p = 0.21), M 35.8-26.4% (p = 0.001), M+R 15.9-23.0% (p = 0.03), and OS 1.8-4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96-91%) with an increased use of OS (4-9%). For the patient cohort undergoing mastectomy, M alone decreased (69-53%); M+R with muscular flap decreased (9-2%); and M+R with implant placement increased (20-40%)-all three trends p < 0.0001. CONCLUSION: The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.
Entities:
Keywords:
Breast conservation surgery; Breast reconstruction; Mastectomy; Surgical incidence; Trend analysis
Authors: Stacey A Carter; Genevieve R Lyons; Henry M Kuerer; Roland L Bassett; Scott Oates; Alastair Thompson; Abigail S Caudle; Elizabeth A Mittendorf; Isabelle Bedrosian; Anthony Lucci; Sarah M DeSnyder; Gildy Babiera; Min Yi; Donald P Baumann; Mark W Clemens; Patrick B Garvey; Kelly K Hunt; Rosa F Hwang Journal: Ann Surg Oncol Date: 2016-07-12 Impact factor: 5.344
Authors: Claudia R Albornoz; Peter B Bach; Babak J Mehrara; Joseph J Disa; Andrea L Pusic; Colleen M McCarthy; Peter G Cordeiro; Evan Matros Journal: Plast Reconstr Surg Date: 2013-01 Impact factor: 4.730
Authors: Claudia R Albornoz; Evan Matros; Clara N Lee; Clifford A Hudis; Andrea L Pusic; Elena Elkin; Peter B Bach; Peter G Cordeiro; Monica Morrow Journal: Plast Reconstr Surg Date: 2015-06 Impact factor: 4.730
Authors: F De Lorenzi; G Hubner; N Rotmensz; V Bagnardi; P Loschi; P Maisonneuve; M Venturino; R Orecchia; V Galimberti; P Veronesi; M Rietjens Journal: Eur J Surg Oncol Date: 2015-09-08 Impact factor: 4.424
Authors: Francesca De Lorenzi; Pietro Loschi; Vincenzo Bagnardi; Nicole Rotmensz; Gabriel Hubner; Giovanni Mazzarol; Roberto Orecchia; Viviana Galimberti; Paolo Veronesi; Marco Angelo Colleoni; Antonio Toesca; Nickolas Peradze; Rietjens Mario Journal: Ann Surg Oncol Date: 2016-02-02 Impact factor: 5.344
Authors: Malke Asaad; Ying Xu; Carrie K Chu; Ya-Chen Tina Shih; Alexander F Mericli Journal: Breast Cancer Res Treat Date: 2020-08-16 Impact factor: 4.872
Authors: Michael M Jonczyk; Carla Suzanne Fisher; Russell Babbitt; Jessica K Paulus; Karen M Freund; Brian Czerniecki; Julie A Margenthaler; Albert Losken; Abhishek Chatterjee Journal: Ann Surg Oncol Date: 2021-02-22 Impact factor: 4.339