Multicentre prospective observational study evaluating recommendations for mastectomy by multidisciplinary teams. Issue 3 (5th November 2019)

• Record Type: Journal Article
• Other Names: Singh Jagdeep K investigator.; McEvoy Katherina investigator.; Marla Sekhar investigator.; Rea Daniel investigator.; Hallissey Michael investigator.; Francis Adele investigator.; Fatayer Hiba investigator.; Murphy Claire investigator.; Pang Calver investigator.; Gomez Kelvin investigator.; Lefemine Valentina investigator.; Zaharan Muhammad investigator.; Gateley Christopher investigator.; Holland Philip investigator.; Mohamud Mohamed investigator.; Dicks Julia investigator.; Khan Shazia Mansoor investigator.; Day Nicola investigator.; Sandi Anita investigator.; Ullah Md Zaker investigator.; Venn Mary investigator.; Chicken Dennis Wayne investigator.; Saad Abdalla investigator.; Salih Ali investigator.; McGoldrick Ciara investigator.; Volleamere Angela J investigator.; Wright Chloe investigator.; Rathinaezhil Rathi investigator.; Ugolini Fiammetta investigator.; Agrawal Amit investigator.; Arima Yuriko investigator.; Benson John investigator.; Forouhi Parto investigator.; Apte Anuradha investigator.; Chakravorty Arunmoy investigator.; Chandrasekharan Sankaran investigator.; Marsh Simon investigator.; Pennell Lesley investigator.; Harding‐Mackean Claudia investigator.; Redmond Elizabeth investigator.; Seward Joanna investigator.; Laine Sarah investigator.; Pooley Gemma investigator.; Ramzi Saed investigator.; Athanasiou Irene investigator.; Olubowale Olumuyiwa investigator.; Rogers Clare investigator.; Wilkinson Nicola investigator.; Crane Peter investigator.; Deol Harleen investigator.; Patani Neill investigator.; Walsh Una investigator.; Wood Jeremy investigator.; Keay Jonathan investigator.; Roshanlall Chandeena investigator.; Pronisceva Veronika investigator.; Sharp Elizabeth investigator.; Clayton Elizabeth investigator.; Ford Jordan investigator.; Kanesalingam Kavita investigator.; Karat Isabella investigator.; Kemeny Catriona investigator.; Khan Asad investigator.; Shah Nikki investigator.; Clark Kevin investigator.; Fasih Tani investigator.; Makam Kishore investigator.; Nangalia Ramlal investigator.; Sein Tin investigator.; Al‐Allak Asmaa investigator.; Bristol James investigator.; Court Fiona investigator.; Fowler Clare investigator.; Hunt Richard investigator.; Kallaway Charlotte investigator.; Llewellyn‐Bennett Rebecca investigator.; Massey Eleanore investigator.; Orchard Philippa investigator.; Vestey Sarah investigator.; Dragoumis Dimitrios investigator.; Laws Siobhan investigator.; Almerie Muhammad Qutayba investigator.; Ray Biswajit investigator.; Hameed Alia investigator.; Haq Anwar investigator.; Adi Rudwan investigator.; Mirza Shaukat investigator.; Gullaksen Elaine investigator.; McManus Penelope investigator.; Mortimer Caroline investigator.; Venn Mary investigator.; Downey Sarah investigator.; Joglekar Sandeep investigator.; Chin Kian investigator.; Kuzhively Raju investigator.; Safdar Gazalla investigator.; Taylor Amanda investigator.; Chopra Sharat investigator.; Johnson Richard investigator.; Krishnan Vummiti Murali investigator.; Arthur Laura investigator.; Musyoka Caroluce investigator.; Abbott Nick investigator.; Pollard Jennifer investigator.; Fitzgerald Kate investigator.; Lannigan Alison investigator.; McCrone Debbie investigator.; McGarry Keith investigator.; McGivern Jayne investigator.; McKenzie Clare investigator.; Murphy Dermot investigator.; Murray Juliette investigator.; Al‐Hattali Samiya investigator.; Macaskill E. Jane investigator.; Ainsworth Rachel investigator.; Dash Isabella investigator.; Ahmad Tanvir investigator.; Groome John investigator.; Moon Charlotte investigator.; Rajaretnam Niroshini investigator.; Heaney Elaine investigator.; McFall Brendan investigator.; Amonkar Sunil investigator.; Aspinall Sebastian investigator.; Carr Michael investigator.; Edwards Karen investigator.; Elliott Helen investigator.; Mann Lynn investigator.; Spence Laura investigator.; Walshe Amanda investigator.; Yousef Magdi investigator.; Akerlund Malin investigator.; Bignell Kym investigator.; Brock Lisa investigator.; Kelsall Jennett investigator.; Otieno Charlene investigator.; Whisker Lisa investigator.; Battersby Nick investigator.; Evans Abigail investigator.; Harvey Kate investigator.; Agrawal Avi investigator.; Zaidi Masooma investigator.; Al‐Gailani Mohamed investigator.; Kumar Inder investigator.; MacInnes Emma investigator.; Ferguson Douglas investigator.; Green Sara investigator.; Youssef Mina investigator.; Ali Oroog investigator.; Hoar Fiona investigator.; McEvoy Katherina investigator.; Rea Ian investigator.; Jafferbhoy Sadaf investigator.; Lake Blossom investigator.; Sheikh Hammad investigator.; Donnelly Peter investigator.; Green Michael investigator.; Ives Charlotte investigator.; Minto Samantha investigator.; Irwin Gareth investigator.; Kirk Stephen investigator.; Clarke Dayalan investigator.; Enser Debbie investigator.; Harries Simon investigator.; Jones Lucie investigator.; Tafazal Habib investigator.; Chagla Leena investigator.; Hodigere Ramesh investigator.; Kiernan Tamara investigator.; Chana Manik investigator.; Thorne Amanda investigator.; Walker Thomas investigator.; Croydon Hilary investigator.; Singh Jagdeep K investigator.; Archampong David investigator.; Johnson Laura investigator.; Micco Rosa Di investigator.; O'Connell Rachel L investigator.; Richardson Caroline investigator.; Rusby Jennifer E investigator.; Soldanova Ludka investigator.; Isgar Brian investigator.; Matey Pilar investigator.; Mylvaganam Senthurun investigator.; Raouf Zaid investigator.; Salem Fathi investigator.; Sircar Tapan investigator.; Vidya Raghavan investigator.; Gvaramadze Anzors investigator.; Sami Amtul investigator.; Thekkinkattil Dinesh Kumar investigator.; Turner Nicky investigator.; Lechi Tracey investigator.; Robertson Stuart investigator.; Waili Ibrahim Al investigator.; Francis Adele investigator.; Magill Laura investigator.; Marla Sekhar investigator.; Perry Rita investigator.; Wilcox Margaret investigator.; Ayaani Soofiyah investigator.; Dean Samera investigator.; Mahmood Mohammed investigator.; Tomlins Abigail investigator.; Appleton Donna investigator.; Kaushik Monika investigator.; Khout Hazem investigator.; Mondani Giuseppina investigator.; Pilgrim Simon investigator.; Rattay Tim investigator.; Gilani Shahid investigator.; Narayanan Sankaran investigator.; Soumian Soni investigator.; Tandon Megha investigator.; Brookes Phil investigator.; Ferguson Henry investigator.; Gaughan Jenni investigator.; Heitmann Marlies investigator.; Iqbal Mohd investigator.; Aitken Jane investigator.; Odofin Olubunmi investigator.; Wosu Chukwuemeka investigator.; Betal Dibendu investigator.; Bonomi Riccardo investigator.; Ainsworth Rachel investigator.; Dash Isabella investigator.; Rossi Chiara investigator.; James Karen investigator.; Vinayagam Raman investigator.; Baker Elizabeth investigator.; Chandra Amrita investigator.; Kim Baek investigator.; Munot Kailas investigator.; Nasr Rana investigator.; Piper Jenny investigator.;
• Is Part Of: British journal of surgery. Volume 107:Issue 3(2020)
• Page Start: 227
• Page End: 237
• Publication Date: 2019-11-05
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11383
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : Background: Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision‐making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in mastectomy rates. Methods: Consecutive patients undergoing mastectomy between 1 June 2015 and 29 February 2016 at participating units across the UK were recruited. Details of neoadjuvant systemic treatment (NST), operative and oncological data, and rationale for recommending mastectomy by MDTs were collected. Results: Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76·9 per cent) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (530 women, 29·1 per cent) and multicentric disease (372, 20·4 per cent). In total, 202 postmenopausal women with oestrogen receptor‐positive (ER+) unifocal tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 173 women (85·6 per cent). Seventy‐five women aged less than 70 years with human epidermal growth factor receptor 2‐positive (HER2+) tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 45 women (60 per cent). Conclusion: Most mastectomies are advised for large tumour to breast size ratio, but there is an inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. The application of standardized recommendations for NST could reduce the number of mastectomies advised by MDTs. Abstract : This study sought to evaluate recommendations for mastectomy by UK multidisciplinary teams (MDTs). Most mastectomies are performed for large tumour to breast size ratio. However, many potentially eligible patients are not offered neoadjuvant systemic therapy (NST) to downsize tumours and facilitate breast conservation. Application of standardized recommendations for NST, resulting in increased and appropriate use, could reduce the number of mastectomies advised by MDTs. Mastecomies can be reduced Abstract : Antecedentes: Las recomendaciones para la mastectomía por equipos multidisciplinarios ( multidisciplinary teams, MDTs) podrían contribuir a explicar la diferencia en las tasas de mastectomía. El objetivo primario de este estudio observacional prospectivo y multicéntrico fue describir la práctica actual en la toma de decisiones de los MDT para recomendar la mastectomía. El objetivo secundario fue determinar factores que contribuyen a la variación en las tasas de mastectomía. Métodos: Se reclutaron pacientes consecutivas sometidas a mastectomía entre el 1 de junio de 2015 y el 29 de febrero de 2016 en las unidades participantes de todo el Reino Unido. Se recogieron datos del preoperatorio, tratamiento neoadyuvante sistémico ( neoadjuvant systemic treatment, NST), quirúrgicos y oncológicos, así como la justificación de los MDT para recomendar la mastectomía. Resultados: Un total de 1.776 pacientes fueron sometidas a 1.823 mastectomías en 68 unidades. La mastectomía fue recomendada por los MDTs en 1.402 (76, 9%) de estas mujeres. Las razones más frecuentes para recomendar la mastectomía fueron la elevada proporción entre el tamaño del tumor y el de la mama (530; 29, 1%) y la enfermedad multicéntrica (372; 20, 4%). En total, a 202 mujeres postmenopáusicas con tumores unifocales positivos para receptores de estrógenos (ER+) se les recomendó la mastectomía y no se les ofreció NST; debido a una elevada proporción entre el tamaño del tumor y de la mama en 173 (86%) pacientes. A 75 mujeres de < 70 años con tumores positivos para el human epidermal growth factor receptor 2 (HER2+) se les recomendó la mastectomía y no se les ofreció NST; debido a una elevada proporción entre el tamaño del tumor y de la mama en 45 (60%) mujeres. Conclusión: La mayoría de las mastectomías se recomendaron en casos con una elevada proporción entre el tamaño del tumor y el de la mama, pero existe una inconsistencia en la utilización de la NST para reducir el tamaño del tumor en pacientes con grandes cánceres ER+ o HER2+. La aplicación de recomendaciones estandarizadas para la NST podría reducir el número de mastectomía recomendadas por los MDT.