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

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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.

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Abbreviations

BCT:

Breast conservative therapy

IBC:

Invasive breast cancer

DCIS:

Ductal carcinoma in situ

PM:

Partial mastectomy

M:

Mastectomy

M+R:

Mastectomy with reconstruction

OS:

Oncoplastic surgery

M+I:

Mastectomy with breast prosthesis, delayed- insertion or tissue expander for implant placement

M+MF:

Mastectomy with muscular flap

SLNB:

Sentinel lymph node biopsy

ALND:

Axillary lymph node dissection

SS:

Sen’s slope

R 2 :

Linear regression

ACS:

American College of Surgeons

NSQIP:

National Surgical Quality Improvement Program

CPT:

Current procedural terminology

ICD-9:

International classification of diseases ninth revision

CG:

Categories

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Acknowledgements

The ACS-NSQIP is not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number TL1TR002546. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA, 02111, USA

    Michael M. Jonczyk & Roger Graham

  2. Department of Plastic Surgery, Tufts Medical Center, 800 Washington Street, South Building, 4th Floor, Boston, MA, 02111, USA

    Abhishek Chatterjee

  3. Clinical Translational Science Program, Tufts University Sackler Graduate School, 136 Harrison Ave #813, Boston, MA, 02111, USA

    Michael M. Jonczyk

  4. Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA

    Jolie Jean

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  1. Michael M. Jonczyk
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Correspondence to Michael M. Jonczyk.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with animals performed by any of the authors. This article does not contain any studies with human participants performed by any of the authors.

Informed consent

The study was reviewed and deemed exempt by Tufts Medical Center Institutional Review Board, given ACS NSQIP database was a de-identified data set. No individual participant consent was required.

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Jonczyk, M.M., Jean, J., Graham, R. et al. Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis. Breast Cancer Res Treat 173, 267–274 (2019). https://doi.org/10.1007/s10549-018-5018-1

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