Abstract P3-13-12: The concept of breast contour preserving surgery as parameter in breast cancer surgery
Authors: van Bommel A , Spronk P , Vrancken Peeters M-J , Mureau M , Siesling S , Smorenburg C , van Dalen T 
Published: May 2019

Background

Breast cancer treatment is a multimodality effort to optimize outcome as well as to achieve the optimal cosmetic result. Various treatment strategies can be used for the latter goal: upfront breast conserving surgery (BCS), BCS after neoadjuvant therapy (NAC), and ablative surgery combined with immediate breast reconstruction. The rate of BCS is frequently used as a quality and trend indicator. The aim of the present study was to analyse the combined efforts expressed as the rate of breast contour preserving procedures (BCPP) and compare it to the rate of BCS.

Material and methods

All invasive M0 female breast cancer patients diagnosed and operated in one of the 89 hospitals in the Netherlands between January 2011 – December 2015 were selected from the national NABON Breast Cancer Audit. BCPP (defined as 'primary BCS', 'BCS after NAC', or 'ablative surgery combined with an immediate reconstruction') was calculated for the years of diagnosis, age groups (&lt;30, 30-39, 40-49, 50-59, 60-69 and ≥ 70 years) and the individual hospitals.

Results

A total of 61,309 patients were identified. The rate of upfront BCS remained stable during the study period (52%), while the BCPP rate increased over the years (63% to 71%) due to an equal increase in the proportions of patients receiving NAC with BCS and undergoing ablative surgery with immediate breast reconstruction. While upfront BCS (with and without NAC) rates increased with age (30% in patients aged &lt;30 years to 67% in patients aged 60-69), the rate of BCPP was more or less stable in these age groups, as the rate of ablative surgery with immediate reconstruction showed an inverse relationship with age, decreasing from 44% in patients &lt;30 years to 1% in patients ≥70 years of age.

The rate of BCS varied between hospitals in the Netherlands: 37% to 77%. Although BCPP is more often performed compared to BCS, the variation between hospitals remained (47% to 88%).

Table. Percentage of patients treated with Breast Conserving Surgery (BCS), BCS after neo-adjuvant therapy and immediate breast reconstruction with ablative surgery resulting in total percentages of Breast Contour Preserving Procedures (BCPP). BCSBCSAblative surgeryBCPP  Neo-adjuvant +IBR + Year of Diagnosis    201153%4%6%63%201253%4%7%64%201352%6%8%67%201452%8%9%69%201552%9%11%71%Age Group    &lt;3017%13%44%73%30-3927%14%26%67%40-4938%12%17%68%50-5956%7%11%75%60-6963%5%5%72%≥ 7049%2%1%52%Hospitals    Mean52%6%8%67%Min34%0%0%47%Max66%26%28%88%BCS: Breast Conserving Surgery; IBR: Immediate Breast Reconstruction; BCPP: Breast Contour Preserving Procedures

Conclusions

While the rate of BCS remained stable over recent years, the rate of BCPP has increased significantly. Including immediate reconstruction into the BCPP rate annihilates observed age-dependent differences of the BCS-rates, while institutional differences remained. All in all, combining different treatment strategies into one parameter (BCPP) provides a more appropriate measure of maintaining the breast contour than BCS alone.

Citation Format: van Bommel A, Spronk P, Vrancken Peeters M-J, Mureau M, Siesling S, Smorenburg C, van Dalen T. The concept of breast contour preserving surgery as parameter in breast cancer surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-12.