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Neoadjuvant Therapy Use as an Indicator of Quality in Breast Cancer Surgery
Ted A James, Laurence E McCahill
University of Vermont, Burlington, VT
Objective: The purpose of this study is to evaluate the use of neoadjuvant therapy (NT), and the associated breast conservation rate (BCR) as a quality assessment indicator in breast cancer surgery.
Design: Data was collected from a two-year, retrospective review of an established breast surgery database. The rate of NT use in a single institution was calculated and correlated to the BCR.
Setting: Tertiary academic medical center within a specialized breast cancer clinic with three dedicated breast cancer surgeons working exclusively within the center.
Patients: In 324 breast cancer operations between 2003-2005 a total of 34 patients received NT for invasive or non-invasive ductal or lobular breast carcinoma, and are the focus of this study.
Interventions: All patients underwent surgical resection for breast cancer.
Main Outcome Measures: 1) Use of NT according to breast tumor size. 2) BCR with respect to NT use.
Results: NT was used in 34/324 (10.5%) cases, and was highest with tumors >5cm (35.3%). BCR was 79.3% for tumors < 3 cm, and decreased to 43.3% with tumors >3 cm. The median pathologic tumor size following NT was 2.15cm
Conclusions: The use of NT was associated with reduction of tumor size and an increased rate of breast conservation. While NT use was most frequent in tumors >5cm, BCR decreased appreciably for tumors >3cm. Even among high volume breast surgeons, NT for tumors >3cm appears underutilized. Strong consideration should be given for NT use for tumors >3cm in women desiring breast conservation.
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