Miscellaneous Publications

On this page you will find information about and links to miscellaneous publications

 

Summary

MAMMA describes the current practice in management of mastitis and breast abscess in UK and Ireland, with a specific focus on the rate of surgical intervention. From 69 participating hospitals, 1312 patient’s data were analysed (Aug 2020 to Aug 2021). Primary outcome measures included patient management pathway characteristics and treatment types (medical/radiological/surgical). MAMMA identified a high overall rate (21%) of breast abscess incision and drainage, and lower than anticipated rate of ultrasound-guided breast abscess aspiration (61%). Between individual units, significant variations were observed in the rate of incision and drainage (range 0–100%; P < 0.001) and needle aspiration (range 12.5–100%; P < 0.001). Overall requirement for inpatient treatment was 22.5%, with 72.9% of these patients requiring IV antibiotics. The odds of undergoing breast abscess incision and drainage or requiring inpatient treatments were significantly higher if patients presented at the weekend vs. weekday (P<0.023). Breast specialists reviewed 40.9% of all patients directly, despite the majority of study cohort (74.2%) presenting within weekday working hours.

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Summary

MonarchE is an open-label, randomised, phase 3 trial which recruited high risk hormone receptor positive, HER2 receptor negative, node-positive breast cancer patients (n=5637). Patients were randomised to receive standard of care 10 years of endocrine therapy +/- abemaciclib for 2 years. High risk disease was defined as 4 or more positive axillary lymph nodes, or between 1 to 3 positive axillary lymph nodes with grade 3 disease or tumour size >5cm. Additionally, further patients with one to 3 positive axillary lymph nodes and ki-67 >20% were also recruited. At 4 years, the invasive DFS was 85.8% in the abemaciclib + endocrine therapy group vs. 79.4% in the endocrine therapy alone group (HR 0.664; p<0.0001). At median follow up of 42 months, 5.6% of patients in the abemaciclib + endocrine therapy group died, as opposed to 6.1% in the endocrine therapy alone group (HR 0.929; P=0.5). The most common grade 3-4 adverse events were neutropenia, leukopenia, and diarrhoea with the addition of abemaciclib. Serious adverse event rate was 15.5% in the abemaciclib + endocrine therapy group vs. 9.1% in the endocrine therapy alone group. Therefore, adjuvant abemaciclib reduces recurrence risk in high risk hormone receptor positive, HER2 receptor negative breast cancer. Further follow up will determine whether this impacts on overall survival outcomes also.

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Summary

Poly(adenosine diphosphate–ribose) polymerase inhibitors target cancers with defects in homologous recombination. This study was a phase 3, double-blind, RCT involving patients with HER2–negative early breast cancer with BRCA1 or BRCA2 or likely pathogenic variants who had received local treatment and neoadjuvant or adjuvant chemotherapy. Patients were randomly assigned (in a 1:1 ratio) to 1 year of oral olaparib or placebo.

The primary end point was invasive disease–free survival. A total of 1836 patients underwent randomization.       The 3-year distant disease–free survival was 87.5% in the olaparib group and 80.4% in the placebo group (difference, 7.1 percentage points; 95% CI, 3.0 to 11.1; hazard ratio for distant disease or death, 0.57; 99.5% CI, 0.39 to 0.83; P<0.001). Olaparib was associated with fewer deaths than placebo (59 and 86, respectively) (hazard ratio, 0.68; 99% CI, 0.44 to 1.05; P=0.02); however, the between-group difference was not significant at an interim-analysis boundary of a P value of less than 0.01. Safety data were consistent with known side effects of olaparib, with no excess serious adverse events or adverse events of special interest.

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Summary

Over the last decade, more than 5 million patients were referred to secondary care with breast symptoms. In 2021-22, 40% of referred patients waited longer than the recommended 14 days for clinic assessment. Urgent referral rates increased considerably after 2015, especially in patients aged 30-59. One significant contributing factor is due to the NICE recommendations, which advocates urgent referral for patients if the breast cancer risk is >3%.  Given these challenges of managing patient referral volumes, breast service review has been recommended. The recently adopted 28 day faster diagnosis standard provides opportunities to enable a more flexible timescales for specialist assessment in different patient groups. For example, although 50% of referrals for women <30 years old are deemed urgent, this patient group has a low cancer detection rate of 0.5%. Male patient referral accounts for 5% of all referrals, and 2/3 are referred along urgent pathway. However, their cancer diagnosis rate is <3% across all age groups. In contrast, women >70 years old have cancer diagnosis rate of >4% even when referred routinely. This patient group accounts for 1/3 of all breast cancer diagnosis. Therefore, risk adopted approaches based on existing national data could reduce time to diagnosis for those at highest risk, alleviate existing service pressures, and maintain adherence to NICE recommendations.  

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Summary

This randomised controlled trial evaluated whether a single bolus dose of 1.2g intravenous Augmentin reduced wound infection at 30 days after breast cancer surgery. 438 patients received prophylactic antibiotics and 433 patients acted as controls without receipt of prophylactic antibiotics. Wound infection rates were 16.2% in the intervention group, compared to 19.2% in the control group (OR 0.82; 95% CI 0.58 to 1.15; p=0.25). Wound infection risk increased for every 5kg/m2 increment in BMI (OR 1.29; 95% CI 1.1 to 1.52; p=0.003). Additionally, patients who were preoperative carriers of staphylococcus aureus had increased risk of wound infection. However, prophylactic antibiotic did not benefit patients with high BMI or carriers of staphylococcus aureus.   

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Summary

This study examines the impact of the COVID-19 pandemic on breast cancer diagnostic services using publicly available data sources (Cancer Waiting Time data / NHSBSP annual report / COVID-19 Rapid Cancer Registration and Treatment Data / COVID-19 Cancer Equity data packs). The overall number of referrals was 9% lower in 2020/21 and 9% higher in 2021/22 when compared to 2019/20 (pre-pandemic). However, the proportion of patients referred urgently was higher during 2020/21 than 2019/20 (10,000 fewer urgent referral s and 48,000 fewer routine referrals in 2020/21 compared to 2019/20). The cancer conversion rate remained similar (5.5% in 2019/20 and 5.7% in 2020/21 for urgent referrals / 1.3% in both time periods for routine referrals). In 2019/20, the number of first treatment for breast cancer was 49,050. This number was 23% lower in 2020/21 and 2% higher in 2021/22. For patients aged 50-69 years, 26% fall in new diagnosis was seen in 2020/21 with 8% increase in 2021/22 (when compared to 2019/20). The data suggests that there may be around 10,300 ‘missing’ women with breast cancer since the start of the pandemic.

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Summary

This study aimed to determine potential association between postoperative complications and survival in breast cancer patients as postoperative complications may activate prometastatic pathways. Patient cohort included 57152 patients who underwent breast cancer surgery (2008-2017). Only major surgical complications requiring re-operation or re-admission within 30 days were considered. Such complications occurred in 1854 patients (3.2%). Overall, 3472 patients (6.1%) died from breast cancer at median follow up of 6.2 years. Major surgical complications were more common after mastectomy with or without immediate breast reconstruction (7.3% and 4.3% respectively) when compared to breast conserving surgery (2.3%). Unadjusted 5 year overall survival (OS) and breast cancer specific survival (BCSS) were 82.6% and 92.1% respectively for patients with major surgical complications, and 88.8% and 95% for patients without such complications. After adjusting for potential confounders, all-cause and breast cancer mortality rates remained higher after major surgical complications (OS: HR 1.32 / BCSS: HR 1.31). After stratification for type of breast surgery, this association remained significant only for patients receiving mastectomy without reconstruction (OS: HR 1.41 / BCSS: HR 1.36).

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Summary

Radiotherapy omission is considered in women >70 years old with ER+ T1N0 tumour post-BCS if the patient receives endocrine therapy (ET). However, the impact of poor adherence to ET on locoregional recurrence (LRR) remains unexplored. This study identified women >70 years old (n=968) with T1-2N0 ER+ breast cancer undergoing BCS without radiotherapy (2004-2019). ET adherence (calculated as duration of treatment over 5 years follow up) was defined as high (<80%) or low (<80%). Within the study cohort, adherence to ET was high in 70%, low in 17%, and 13% took no ET. On multivariate analysis, tumour size (HR 1.67; p=0.04) and high adherence to ET (HR 0.13; p<0.001) were significantly associated with LRR. The 5 year LRR rates were 3.1% with high adherence, 14.7% with low adherence, and 17.9% with no ET. Therefore, higher rates of LRR rates were observed in 30% of women low adherence or no ET.

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Summary

This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding breast cancer locoregional recurrence (LRR) management. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy. In total, 822 MDT members across 42 breast units participated in the NPQ (Feb-Aug 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%). For patients treated with BCS and radiotherapy, few units (7%) always/usually offered repeat BCS. In the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with local recurrence following previous BCS and SLNB, most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure. For ER+HER2- node negative LRR, 10% of units always/usually offered chemotherapy. For ER+HER2- node positive LRR, this recommendation increased to 64%. For triple negative LRR, 90% of units always/usually offered chemotherapy. Further research is required to determine how these management patterns influence patient outcomes, which will refine optimal treatment pathways.

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Summary

Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) is a surgical procedure which aims to decrease lymphoedema rates in patients receiving axillary lymph node dissection (ALND). The study cohort included patients undergoing ALND +/- SLYMPHA (2014-2020; n=197). Bioimpedance spectroscopy (L-Dex) score outside the normal range (+/-10 L-Dex unit) or >10 L-Dex unit increase above the patient’s baseline were defined as lymphoedema. SLYMPHA was performed in 57% of the study cohort (mean follow up 47 months). Patients who received SLYMPHA had significantly lower rate of lymphoedema (16% vs. 32%; p=0.01; OR 0.4).

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Summary

This cohort study aimed to determine the outcomes of women who had no surgery for screen-detected DCIS. English breast screening databases were utilised to identify patients diagnosed with DCIS without invasive cancer at screening with no record of surgery within 6 months of diagnosis. Data was available for 311 patients (median age 62 years). 60 patients subsequently developed invasive cancer (56 ipsilateral and 4 contralateral). The ipsilateral invasive cancer risk increased linearly with time. The 10-year cumulative risk of ipsilateral invasive breast cancer was 9%, 39%, and 36% for low, intermediate, and high grade DCIS respectively. Other associated factors that increased this cumulative risk included younger age, larger DCIS lesions, and associated microinvasion. Most subsequent invasive cancers that developed were grade 2 or 3. Therefore, active surveillance may be reasonable alternative to surgery in patients with low grade DCIS. However, patients with intermediate or high grade DCIS should be offered surgery. The study highlights the importance of reproducible DCIS grading to guide patient management.

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Summary

This IDEAL stage 2a/2b platform cohort study examined the effectiveness localisation and removal of the index lesion using wires vs. magnetic seeds. From 35 units, 2300 patients were recruited (Aug 2018-Aug 2020). Index lesion identification rate was 99.8% for magnetic seeds (n=946) and 99.1% for wires (n=1170). For patients undergoing breast conserving surgery for lesions <50mm (n=1746), there were no differences in median closest margin (2mm vs. 2mm), re-excision rate (12% vs. 13%), and specimen weight in relation to lesion size (0.15g/mm2 vs. 0.14g/mm2). Therefore, magnetic seed localisation demonstrated similar safety and effectiveness when compared to wire localisation.

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Summary

This randomised controlled trial (n=307) investigated the use of prophylactic compression sleeves to prevent arm swelling post-axillary lymph node dissection. The compression sleeves were used until 3 months after completing adjuvant treatments. Arm swelling was measured using bioimpedance spectroscopy (BIS) and relative arm volume increase (RAVI). Hazard ratio for developing arm swelling in the compression group relative to the control group was 0.61 (p=0.004) using BIS and 0.56 (p=0.034) using RAVI. The estimated cumulative incidence of arm swelling was lower in the compression group using BIS (42% vs. 52%) and RAVI (14% vs. 25%) measurements. Therefore, prophylactic compression sleeves reduced arm swelling in women at high risk of lymphodema in the first year after breast cancer surgery.

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Summary

This prospective cohort study categorised the patient’s presenting symptoms to a breast clinic (over 12 months) to 4 distinct clinical groups in order to investigate cancer incidence. Of 10830 women, 19% were referred with breast pain, 62% with lumps, 4% with nipple symptoms, and 15% with ‘other’ symptoms. Mammograms, performed in 56.4% of women with breast pain, identified breast cancer in 0.7%. Overall breast cancer incidence was 0.4% for patients who present with breast pain. However, breast cancer incidence was 5% in each of the other 3 clinical groups. Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net QALY loss -0.012). This study demonstrates that alternative management pathways for breast pain are required to improve capacity and reduce financial burden.

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Summary

This EBCTCG meta-analysis investigated whether pre-menopausal women treated with ovarian suppression benefited from aromatase inhibitors (AIs). Meta-analysis was performed from individual patient data from RCTs (ABCSG XII, SOFT, TEXT, and HOBOE trials) comparing AIs vs. tamoxifen in pre-menopausal women with ER+ breast cancer receiving ovarian suppression. Data analysis was performed for 7030 women with ER+ breast cancer enrolled between 1999 to 2015 (median follow up of 8 years). Breast cancer recurrence rate was lower for women allocated to AI as opposed to tamoxifen (RR 0.79; p=0.0005). The main benefit was seen in years 0-4 (RR 0.68; p<0.0001), with a 3.2% absolute reduction in 5 year recurrence risk (6.9% vs. 10.1%). No further benefit was seen in years 5-9 or beyond year 10. Distant recurrence was reduced with AIs (RR 0.83; p=0.018). No significant differences were observed for breast cancer mortality (RR 1.01; p=0.94), death without recurrence (1.3; p=0.34), or all-cause mortality (RR 1.04; p=0.68). More bone fractures were observed with AIs when compared to tamoxifen (6.4% vs. 5.1%; p=0.017). Endometrial cancer was rare (0.2% AI group vs. 0.3% tamoxifen group; p=0.14). This meta-analysis shows that using AIs rather than tamoxifen in pre-menopausal women receiving ovarian suppression reduces breast cancer recurrence risks. Longer term follow-up is required to assess any impact on survival outcomes.    

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Summary

This prospective randomised trial assigned postmenopausal women with HR-positive breast cancer who had received 5 years of adjuvant endocrine therapy (n=3484) to receive either additional 2 or 5 years of anastrozole. After a median follow-up of 118 months, disease progression or death occurred in 335 women in each treatment group with no differences in disease free survival (HR, 0.99; 95% CI; 0.85 to 1.15; p=0.9). No between-group differences occurred in secondary endpoints including overall survival, contralateral breast cancer, and second primary breast cancer. However, the risk of clinical bone fracture was higher in the 5-year group (HR, 1.35; 95% CI; 1.00 to 1.84).

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Summary

This study aimed to identify characteristics that are associated with negative pathological node (ypN0) in patients with clinically node-negative (cN0) breast cancer treated with NACT. This cohort study included patients with cT1-3 cN0 breast cancer treated with NACT (2013 to 2018). Overall, 85.5% (259/303 patients) achieved ypN0, with high rates among those with a radiologically complete response (rCR) on breast MRI (95.5%). Some 82% of patients with HR+ breast cancer, 98% of patients with TNBC, and all patients with HER2+ breast cancer who had rCR achieved ypN0. Multivariate analysis showed that HER+ (OR 5.77; 95% CI 1.91 to 23.13) and TNBC subtype (OR 11.65; 95% CI 2.86 to 106.89) were associated with ypN0 status.

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Summary

This pooled analysis of 2310 patients from four neoadjuvant clinical trials examined survival and treatment response in patients with HER2-low-positive (immunohistochemistry 1+ or 2+/in-situ hybridisation negative; n=1098) versus HER2-zero (immunohistochemistry0; n=1212) breast cancer. HER2-low-positive tumours had significantly lower pathological complete response (29.2% vs. 39%; p=0.0002). This was also seen in the hormone receptor positive subgroup (17.5% vs. 23.6%; p=0.024), but not in the hormone receptor negative subgroup (50.1% vs. 48%; p=0.21). Patients with HER2-low-positive tumours had significantly longer survival (3 year DFS 83.4% vs. 76.1%; p=0.0084). This was seen in hormone receptor negative tumours (3 year DFS 84.5% vs. 74.4%; p=0.0076), but not in hormone receptor positive tumours (3 year DFS 82.8% vs. 79.3%; p=0.39).  

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Summary

This meta-analysis, including 14 studies (n=19819), evaluates the safety of breast conserving surgery (BCS) in triple negative breast cancer. 9828 patients underwent BCS (49.6%) and 9991 patients (50.4%) underwent mastectomy. The pooled odds ratio (OR) for locoregional recurrence was 0.64 (0.48 to 0.85; p=0.002) indicating lower odds for LRR for women who had BCS as opposed to mastectomy.  The pooled OR for distant metastasis was 0.7 (0.53 to 0.94; p=0.02) indicating lower odds of distant metastasis for women who underwent BCS. This difference diminished with follow up time. Pooled hazard ratio of 0.78 (0.69 to 0.89; p<0.001) showed lower hazard ratio for all-cause mortality among women treated with BCS.

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Summary

This cohort study used prospectively collected national data and included women diagnosed with primary invasive T1-2 N0-2 breast cancer. Patients underwent breast surgery in Sweden (2008-2017; n=48986 with median follow up of 6.28 years). Patients received BCS and radiotherapy (n=29367; 59.9%), mastectomy without radiotherapy (n=12413; 25.3%), or mastectomy with radiotherapy (n=7206; 14.7%). 5 year OS was 91.1% and BCSS was 96.3%. OS and BCSS were significantly worse after mastectomy without radiotherapy (HR 1.79 and HR 1.66 respectively) and mastectomy with radiotherapy (HR 1.24 and HR 1.26 respectively) than after BCS and radiotherapy. 

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Summary

This is a phase 3, double-blind, randomised trial which recruited HER2- early breast cancer patients with BRCA1/2 germline pathogenic or likely pathogenic variants (n=1836). Study participants received local therapy with adjuvant or neoadjuvant chemotherapy with patients subsequently randomised to 1 year or Olaparib or placebo. At median follow up of 2.5 years, the 3-year invasive DFS was 85.9% in the Olaparib v. 77.1% in the placebo group (HR for invasive disease or death; 0.58; p<0.001). The 3-year distant DFS was 87.5% in the Olaparib group and 80.4% in the placebo group (HR for distant disease or death; 0.57; p<0.001). No excess serious adverse events were identified with Olaparib administration. Therefore, adjuvant Olaparib was associated with significantly longer survival free of invasive or distant disease in this patient group.

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Summary

This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer (n=3416 with 56 UK breast units who participated). Adverse effects on quality-of-life outcomes were seen in the first few months after surgery, which largely resolved by 24 months.

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This manuscript was produced on behalf of the academic section of the Association of Breast Surgery and submitted to the Royal College of Surgeons working group on the ‘Future of Surgery’. The article summarises the impact of innovations in science and technology on the future management of breast cancer. The article focuses on genomic advances, de-escalation of surgery, optimisation of breast conserving surgery, neoadjuvant therapy, technologies to improve breast cancer staging, innovations in reconstructive breast surgery, patient follow up and survivorship, and breast cancer surgical research.

Summary

The B-Map-C investigated alterations to breast cancer management during the peak transmission period of the UK COVID-19 pandemic (March to May 2020). 64 UK breast units participated (n=3776) with 59% determined to have had ‘COVID-altered’ management. However, the majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer outcomes are unlikely to be negatively impacted.

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Summary

Significant concerns have been raised about the impact of COVID-19 on the delivery of NHS cancer service. This report compares breast cancer service referral and treatment activity in 2020 and 2021, compared to those in 2019 (pre-pandemic). Data were extracted from the Cancer Waiting Times data set and the COVID-19 Cancer Equity Data Packs. Compared to 2019, there was 33% fewer urgent and 40% fewer routine referrals in the first half of 2020. Urgent referral activity had returned to usual level s by August 2020 and by the first half of 2021, the volume of urgent referral was 10% higher when compared to 2019. The volume of routine referrals remained 16% fewer however. Compared to 2019, there were 16% fewer first treatments for breast cancer in the first half of 2020. There were 19% fewer treatments in the second half of 2020, and only 3% fewer treatments in the first half of 2021. The monthly number of first treatments recovered by December 2020, with the slowest recovery seen in patients aged 50-69 years (population-based screening age group). This reduction in the number of first treatments suggest that there may be approximately 9500 ‘missing’ breast cancer diagnoses since the start of 2020 due to the pandemic. Half of these are likely to be due to reduced screening activity (March to September 2020), and remainder due to the reduction in the number of referral.

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Roszkowski N, Lam SS, Copson E, Cutress RI, Oeppen R. Expanded criteria for pretreatment staging CT in breast cancer. BJS Open. 2021 Mar 5;5(2):zraa006. doi: 10.1093/bjsopen/zraa006. PMID: 33715004; PMCID: PMC7955978.

 

Summary

This study sought to identify factors predictive of distant metastatic disease at presentation to enable appropriate selection of patients for pretreatment CT. A total of 1377 patients with newly diagnosed breast cancer were identified, of whom 1025 had complete data; 323 staging CT examinations were performed. Distant metastases were identified at presentation in 47 (4.6 per cent).Some 30 of 47 patients with metastatic disease met established criteria for staging (T4, recurrence, symptoms of possible distant metastases), leaving 17 patients with metastatic disease potentially missed by use of these criteria alone. Multivariable analysis showed that tumour size at least 3 cm combined with sonographically abnormal axillary lymph nodes predicted a high probability of distant metastatic disease at pre- sentation (positive predictive value 18.8 per cent, odds ratio 4.83, P < 0.001).

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Summary

This study aimed to examine the planned long-term recurrence and survival outcomes from the ELIOT trial. Eligible women, aged 48-75 years with a clinical diagnosis of a unicentric breast carcinoma with an ultrasound diameter not exceeding 25 mm, clinically negative axillary lymph nodes, and who were suitable for breast-conserving surgery, were randomly assigned (1:1) via a web-based system, with a random permuted block design (block size of 16) and stratified by clinical tumour size, to receive post-operative whole breast irradiation (WBI) with conventional fractionation (50 Gy given as 25 fractions of 2 Gy, plus a 10 Gy boost), or 21 Gy intraoperative radiotherapy with electrons (ELIOT) in a single dose to the tumour bed during surgery. The trial was open label and no-one was masked to treatment group assignment. The primary endpoint was the occurrence of IBTR. After a median follow-up of 12·4 years (IQR 9·7-14·7), 86 (7%) patients developed IBTR, with 70 (11%) cases in the ELIOT group and 16 (2%) in the WBI group, corresponding to an absolute excess of 54 IBTRs in the ELIOT group (HR 4·62, 95% CI 2·68-7·95, p<0·0001). At final follow-up on March 11, 2019, 193 (15%) women had died from any cause, with no difference between the two groups (98 deaths in the ELIOT group vs 95 in the WBI group; HR 1·03, 95% CI 0·77-1·36, p=0·85.

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British Journal of Surgery: Feb 2020 

This study examines whether biological subtype in patients diagnosed with inflammatory breast cancer (IBC) influences their outcome using a national cancer database. Amongst 4068 patients diagnosed with IBC, 38.7% were ER+HER2-, 32.5% HER2+, and 28.8% were ER-HER2-. 84% were clinically node positive at presentation. Total pCR rates were 6.2% (ER+HER2-), 38.8% (HER2+), and 19.1% (ER-/HER2-). The 5 year overall survival was rates were 64.9% (ER+HER2-), 74% (HER2+), and 44% (ER-/HER2-). Multivariate analysis showed that ER-/HER2- subtype and the absence of pCR predicted for worse survival. The study findings support the concept that IBC is not a distinct biological entity with uniformly poor outcomes and highlights the recent improved outcomes in HER2+ IBC. However, future studies are needed to improve outcome for patients with ER-/HER2- IBC. 

Medication to Reduce Risk of Breast Cancer: USPS Task Force Recommendation

Journal: JAMA

Young patients with breast cancer and BRCA mutation have similar survival to sporadic breast cancer patients (POSH trial)

Journal: Lancet Oncol

TEAM study

Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery

Journal: Brit J Surg

RCT Lymphoedema rates reduced with reverse mapping

Journal: Ann Surg Oncol

S-LYMPHA (simplified LYMPHA) may reduce rates of lymphoedema after axillary clearance

Journal: Annals of Surgery

BRASS  Jenny Banks

Breast Angiosarcoma Surveillance Study (BRASS) – A National Audit of Management and Outcomes of Angiosarcoma of the Breast and Chest Wall

The BRASS study is a collaborative project led by practising breast and plastic surgeons in the UK and ROI.