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Review
. 2019 Jan;173(2):267-274.
doi: 10.1007/s10549-018-5018-1. Epub 2018 Oct 25.

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Michael M Jonczyk  1   2 , Jolie Jean  3 , Roger Graham  4 , Abhishek Chatterjee  5
Affiliations
Review

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Michael M Jonczyk et al. Breast Cancer Res Treat. 2019 Jan.

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.

Keywords: Breast conservation surgery; Breast reconstruction; Mastectomy; Surgical incidence; Trend analysis.

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Methods schematic
Fig. 2
Fig. 2
Breast Cancer Surgical Trends: Trends are based off of the surgical categorization. Each year equals 100% of breast cancer interventions done within that year; PM partial mastectomy, OS oncoplastic surgery, M mastectomy (simple + radical), M+I mastectomy and implant placement, M+F mastectomy, and flap reconstruction
See this image and copyright information in PMC

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