Abstract and Background
Abstract
Background: Over the last decade there has been a paradigm shift in the management of breast cancer, subsequent to revised surgical oncology guidelines and consensus statements which were derived in light of landmark breast cancer clinical trials conducted throughout the latter part of the 20th century. However the sheer impact of this paradigm shift upon all modalities of treatment, and the current trends in management of the disease, are largely unknown. We aimed to assess the changing practices of breast cancer management over the last decade within a specialist tertiary referral Breast Cancer Centre.
Methods: Comparative analysis of all aspects of the management of breast cancer patients, who presented to a tertiary referral Breast Cancer Centre in 1995/1996 and 2005/2006, was undertaken and measured against The European Society for Surgical Oncology guidelines for the surgical management of mammographically detected lesions [1998].
Results: 613 patients' case profiles were analysed. Over the last decade we observed a dramatic increase in incidence of breast cancer [> 100%], a move to less invasive diagnostic and surgical therapeutic techniques, as well as increased use of adjuvant therapies. We also witnessed the introduction of immediate breast reconstruction as part of routine practice
Conclusion: We demonstrate that radical changes have occurred in the management of breast cancer in the last decade, in keeping with international guidelines. It remains incumbent upon us to continue to adapt our practice patterns in light of emerging knowledge and best evidence.
Background
Breast cancer is the commonest female malignancy in the developed world, and its incidence continues to rise. The Irish National Cancer Registry predicts that by 2020 there will be approximately 5000 new cases per annum in Ireland. Over the past two decades awareness of the disease has increased dramatically, and in conjunction with increasing knowledge and understanding the management of breast cancer has evolved. Following several landmark clinical trials conducted throughout the mid to latter part of the 20th century [Veronesi, Sarrazin, Fisher, 2-7], the mid-1990s saw the publication of numerous sets of guidelines advocating a less radical surgical therapeutic approach, when combined with adjuvant radiotherapy, encouraging increased use of systemic therapies for estrogen responsive tumours, emphasising the importance of multidisciplinary team management, and highlighting a growing awareness of the psychosocial needs of breast cancer patients. The European Society for Surgical Oncology put forth recommendations which included specific targets and outcome measures, and a proposed framework for surgical quality assurance in breast cancer units, and recommended that these guidelines be reviewed and modified in 3 years in light of new knowledge. Since the publication of these guidelines there has been a paradigm shift in the management of breast cancer, towards less invasive diagnostic modalities and surgical approach, which has ameliorated both the physical and psychological morbidity for women with this disease. The introduction of breast cancer screening has changed the type and stage of disease at presentation, and poses specific therapeutic challenges. Newer more specific adjuvant therapies and protocols have been trialled and are in widespread clinical use. The emphasis on women's psychosocial health following breast cancer treatment has drawn attention to the aesthetic outcome and the potential benefits of immediate breast reconstruction. However the sheer impact of this paradigm shift upon all modalities of treatment and the current trends in management of the disease are largely unknown. We aim to assess the changing practices of breast cancer management over the last decade within a specialist tertiary referral Breast Cancer Centre.