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Oncoplastic breast surgery in elderly primary breast cancer: time to serve more surgically?

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Over 30% of breast cancers in the UK are diagnosed in elderly women (age ≥ 70). Women in this age group are less likely to undergo primary surgery for breast cancer, and those who are treated with surgery are more likely to receive a mastectomy. Compared to simple wide local excision, oncoplastic breast surgery (OBS) can reduce re-operation rates, including in larger cancers, and yet maintain/improve breast aesthetics. Despite these advantages, older women are largely underrepresented in the available literature.

Methods

To explore the utility of OBS in women aged ≥ 70 years in a well-established surgical practice, a retrospective review of patients undergoing breast-conserving surgery was performed. Tumour characteristics, operative variables and adjuvant treatment details of elderly patients were compared with the younger cohort.

Results

A total of 325 patients underwent breast-conserving surgery during the study period including 60 who underwent OBS (22.64%). In fit/operable elderly women, despite greater cancer size, OBS was minimal (n = 1/52, 1.96%), likely due to multi-factorial reasons such as the multidisciplinary team’s subconscious age bias or assumptions against qualitatively escalated surgery. In contrast, more patients (n = 6/52, 11.76%) were deemed fit for cytotoxic chemotherapy.

Conclusions

Whilst OBS-related benefits certainly should be weighed against the increased risks of a longer operative time and recovery, balanced considerations should be made when considering the escalation of systemic adjuvant treatments and related side-effects vis-à-vis de-escalation of surgery and relation to physical and psychological considerations.

Level of Evidence: Level IV, Risk / Prognostic Study.

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References

  1. Cancer Research UK. https://www.cancerresearchuk.org. Date accessed 06 Mar. 22

  2. National Audit of Breast Cancer in Older Patients. Annual report. 2018. https://www.nabcop.org.uk/reports/nabcop-2018-annual-report.

  3. Bali R, Kankam HKN, Borkar N, Provenzano E, Agrawal A (2018) Wide local excision versus oncoplastic breast surgery: differences in surgical outcome for an assumed margin (0, 1, or 2 mm) distance. Clin Breast Cancer 18(5):e1053–e1057

    Article  PubMed  Google Scholar 

  4. Kosasih S, Tayeh S, Mokbel K, Kasem A (2020) Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. Am J Surg 220(2):385–392

    Article  PubMed  Google Scholar 

  5. James R, McCulley SJ, Macmillan RD (2015) Oncoplastic and reconstructive breast surgery in the elderly. Br J Surg 102(5):480–488

    Article  CAS  PubMed  Google Scholar 

  6. Dodwell D, Jauhari Y, Gathani T, Cromwell D, Gannon M, Clements K, Horgan K (2020) Treatment variation in early breast cancer in the UK. BMJ 1(371):m4237

    Article  Google Scholar 

  7. Derks MGM, Bastiaannet E, Kiderlen M, Hilling DE, Boelens PG, Walsh PM, van Eycken E, Siesling S, Broggio J, Wyld L, Trojanowski M, Kolacinska A, Chalubinska-Fendler J, Gonçalves AF, Nowikiewicz T, Zegarski W, Audisio RA, Liefers GJ, Portielje JEA, van de Velde CJH; EURECCA Breast Cancer Group (2018) Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group. Br J Cancer 119(1):121–129

  8. Quddus R, Morgan J, Reed MW, Cheung KL, Audisio R, Wyld L. (2022) Outcomes of complex oncoplastic procedures in UK women over the age of 70. Analysis of data from the Age Gap cohort study [abstract]. Eur J Surg Oncol 48(2):e29-e43

  9. Aristokleous I, Öberg J, Pantiora E, Sjökvist O, Navia JE, Mani M, Karakatsanis A (2022) Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: a cross-sectional study. Eur J Surg Oncol 30:S0748–7983(22)00628-X

  10. Coleman R (2019) Clinical benefits of bone targeted agents in early breast cancer. Breast 48(Suppl 1):S92–S96

    Article  PubMed  Google Scholar 

  11. Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, Hanna G, Jagsi R, Kaidar Person O, Kirby A, Mjaaland I, Meattini I, Luis AM, Marta GN, Offersen B, Poortmans P, Rivera S (2020) International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 32(5):279–281

    Article  CAS  PubMed  Google Scholar 

  12. Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13(4):e148–e160

    Article  PubMed  Google Scholar 

  13. Agrawal A (2016) Assessment and planning for oncoplastic and reconstructive breast surgery: a review and a proposed chart. Eur J Plast Surg 39:321–330. https://doi.org/10.1007/s00238-016-1221-7

    Article  Google Scholar 

  14. O'Connell RL, Baker E, Trickey A, Rattay T, Whisker L, Macmillan RD, Potter S; TeaM Steering Group; Mammary Fold Academic and Research Collaborative (2018) Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. Br J Surg 105(13):1778–1792

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Funding

No funding was provided by any source for this study.

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Authors and Affiliations

  1. Breast Surgery, University Hospitals of Derby and Burton, Derby, DE22 3NE, UK

    Emanuele Garreffa

  2. Breast Surgery, Cambridge University Hospitals, Cambridge, UK

    Amit Agrawal

Authors
  1. Emanuele Garreffa
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  2. Amit Agrawal
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Contributions

EG: study design, data collection, data analysis and interpretation, and manuscript writing and editing.

AA: study concept, study design, data analysis and interpretation, and manuscript editing and review.

The authors read and approved the final manuscript.

Corresponding author

Correspondence to Amit Agrawal.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was not necessary for this retrospective study according to the UK law and ethical guidelines.

Informed consent

Informed consent was obtained by all individual patients included in the study.

Conflict of interest

The authors declare no competing interests.

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Garreffa, E., Agrawal, A. Oncoplastic breast surgery in elderly primary breast cancer: time to serve more surgically?. Eur J Plast Surg 46, 215–218 (2023). https://doi.org/10.1007/s00238-022-02009-1

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  • DOI: https://doi.org/10.1007/s00238-022-02009-1

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