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Current Oncology
Volume 29
Issue 1
10.3390/curroncol29010013
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Article

De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada?

by
Hannah Kapur
1,2,
Leo Chen
2,
Rebecca Warburton
1,2,
Jin-Si Pao
1,2,
Carol Dingee
1,2,
Urve Kuusk
1,2,
Amy Bazzarelli
1,2 and
Elaine McKevitt
1,2,*
1
Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
2
Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(1), 144-154; https://doi.org/10.3390/curroncol29010013
Submission received: 6 November 2021 / Revised: 19 December 2021 / Accepted: 24 December 2021 / Published: 29 December 2021
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Abstract

Quality Indicators (QIs), including the breast-conserving surgery (BCS) rate, were published by the European and American Breast Cancer Societies and this study assesses these in a Canadian population to look for opportunities to de-escalate surgery. A total of 2311 patients having surgery for unilateral, unifocal breast cancer between 2013 and 2017 were identified and BCS QIs calculated. Reasons for mastectomy had been prospectively collected with synoptic operative reporting. Our BCS rate for invasive cancer < 3 cm was 77.1%, invasive cancer < 2 cm was 84.1%, and DCIS < 2 cm was 84.9%. There was no statistically significant change in BCS rates over a five-year period, but there was a reduction in contralateral prophylactic mastectomies (CPM) from 28% in 2013 to 16% in 2017 (p < 0.001). Trend analysis looking at tumour size and medical need for mastectomy indicated that 80% of patients at our centre would be eligible for BCS with tumour cut off of 2.5 cm. Our institution met American but not European QI standards for BCS rates, potentially indicating a difference in patient demographics compared to Europe. Our results support the understanding that BCS rates are influenced by multiple factors and are challenging to compare across jurisdictions. CPM rates may offer a more actionable opportunity to de-escalate surgery for breast cancer.
Keywords: breast neoplasms; mastectomy; segmental; mastectomy; quality indicators; health care breast neoplasms; mastectomy; segmental; mastectomy; quality indicators; health care

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MDPI and ACS Style

Kapur, H.; Chen, L.; Warburton, R.; Pao, J.-S.; Dingee, C.; Kuusk, U.; Bazzarelli, A.; McKevitt, E. De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada? Curr. Oncol. 2022, 29, 144-154. https://doi.org/10.3390/curroncol29010013

AMA Style

Kapur H, Chen L, Warburton R, Pao J-S, Dingee C, Kuusk U, Bazzarelli A, McKevitt E. De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada? Current Oncology. 2022; 29(1):144-154. https://doi.org/10.3390/curroncol29010013

Chicago/Turabian Style

Kapur, Hannah, Leo Chen, Rebecca Warburton, Jin-Si Pao, Carol Dingee, Urve Kuusk, Amy Bazzarelli, and Elaine McKevitt. 2022. "De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada?" Current Oncology 29, no. 1: 144-154. https://doi.org/10.3390/curroncol29010013

APA Style

Kapur, H., Chen, L., Warburton, R., Pao, J.-S., Dingee, C., Kuusk, U., Bazzarelli, A., & McKevitt, E. (2022). De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada? Current Oncology, 29(1), 144-154. https://doi.org/10.3390/curroncol29010013

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