부산대학교 도서관

Background Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision-making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in mastectomy rates. Methods Consecutive patients undergoing mastectomy between 1 June 2015 and 29 February 2016 at participating units across the UK were recruited. Details of neoadjuvant systemic treatment (NST), operative and oncological data, and rationale for recommending mastectomy by MDTs were collected. Results Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76*9 per cent) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (530 women, 29*1 per cent) and multicentric disease (372, 20*4 per cent). In total, 202 postmenopausal women with oestrogen receptor-positive (ER+) unifocal tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 173 women (85*6 per cent). Seventy-five women aged less than 70years with human epidermal growth factor receptor 2-positive (HER2+) tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 45 women (60 per cent). Conclusion Most mastectomies are advised for large tumour to breast size ratio, but there is an inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. The application of standardized recommendations for NST could reduce the number of mastectomies advised by MDTs. CAPTION(S): Appendix S1. Fig. S1 Mastectomy rate for each English breast unit, and relationship between unit and mastectomy rate and proportion of patients recommended mastectomy Byline: , Jagdeep K Singh, Katherina McEvoy, Sekhar Marla, Daniel Rea, Michael Hallissey, Adele Francis, Hiba Fatayer, Claire Murphy, Calver Pang, Kelvin Gomez, Valentina Lefemine, Muhammad Zaharan, Christopher Gateley, Philip Holland, Mohamed Mohamud, Julia Dicks, Shazia Mansoor Khan, Nicola Day, Anita Sandi, Md Zaker Ullah, Mary Venn, Dennis Wayne Chicken, Abdalla Saad, Ali Salih, Ciara McGoldrick, Angela J Volleamere, Chloe Wright, Rathi Rathinaezhil, Fiammetta Ugolini, Amit Agrawal, Yuriko Arima, John Benson, Parto Forouhi, Anuradha Apte, Arunmoy Chakravorty, Sankaran Chandrasekharan, Simon Marsh, Lesley Pennell, Claudia Harding-Mackean, Elizabeth Redmond, Joanna Seward, Sarah Laine, Gemma Pooley, Saed Ramzi, Irene Athanasiou, Olumuyiwa Olubowale, Clare Rogers, Nicola Wilkinson, Peter Crane, Harleen Deol, Neill Patani, Una Walsh, Jeremy Wood, Jonathan Keay, Chandeena Roshanlall, Veronika Pronisceva, Elizabeth Sharp, Elizabeth Clayton, Jordan Ford, Kavita Kanesalingam, Isabella Karat, Catriona Kemeny, Asad Khan, Nikki Shah, Kevin Clark, Tani Fasih, Kishore Makam, Ramlal Nangalia, Tin Sein, Asmaa Al-Allak, James Bristol, Fiona Court, Clare Fowler, Richard Hunt, Charlotte Kallaway, Rebecca Llewellyn-Bennett, Eleanore Massey, Philippa Orchard, Sarah Vestey, Dimitrios Dragoumis, Siobhan Laws, Muhammad Qutayba Almerie, Biswajit Ray, Alia Hameed, Anwar Haq, Rudwan Adi, Shaukat Mirza, Elaine Gullaksen, Penelope McManus, Caroline Mortimer, Mary Venn, Sarah Downey, Sandeep Joglekar, Kian Chin, Raju Kuzhively, Gazalla Safdar, Amanda Taylor, Sharat Chopra, Richard Johnson, Vummiti Murali Krishnan, Laura Arthur, Caroluce Musyoka, Nick Abbott, Jennifer Pollard, Kate Fitzgerald, Alison Lannigan, Debbie McCrone, Keith McGarry, Jayne McGivern, Clare McKenzie, Dermot Murphy, Juliette Murray, Samiya Al-Hattali, E. Jane Macaskill, Rachel Ainsworth, Isabella Dash, Tanvir Ahmad, John Groome, Charlotte Moon, Niroshini Rajaretnam, Elaine Heaney, Brendan McFall, Sunil Amonkar, Sebastian Aspinall, Michael Carr, Karen Edwards, Helen Elliott, Lynn Mann, Laura Spence, Amanda Walshe, Magdi Yousef, Malin Akerlund, Kym Bignell, Lisa Brock, Jennett Kelsall, Charlene Otieno, Lisa Whisker, Nick Battersby, Abigail Evans, Kate Harvey, Avi Agrawal, Masooma Zaidi, Mohamed Al-Gailani, Inder Kumar, Emma MacInnes, Douglas Ferguson, Sara Green, Mina Youssef, Oroog Ali, Fiona Hoar, Katherina McEvoy, Ian Rea, Sadaf Jafferbhoy, Blossom Lake, Hammad Sheikh, Peter Donnelly, Michael Green, Charlotte Ives, Samantha Minto, Gareth Irwin, Stephen Kirk, Dayalan Clarke, Debbie Enser, Simon Harries, Lucie Jones, Habib Tafazal, Leena Chagla, Ramesh Hodigere, Tamara Kiernan, Manik Chana, Amanda Thorne, Thomas Walker, Hilary Croydon, Jagdeep K Singh, David Archampong, Laura Johnson, Rosa Di Micco, Rachel L O'Connell, Caroline Richardson, Jennifer E Rusby, Ludka Soldanova, Brian Isgar, Pilar Matey, Senthurun Mylvaganam, Zaid Raouf, Fathi Salem, Tapan Sircar, Raghavan Vidya, Anzors Gvaramadze, Amtul Sami, Dinesh Kumar Thekkinkattil, Nicky Turner, Tracey Lechi, Stuart Robertson, Ibrahim Al Waili, Adele Francis, Laura Magill, Sekhar Marla, Rita Perry, Margaret Wilcox, Soofiyah Ayaani, Samera Dean, Mohammed Mahmood, Abigail Tomlins, Donna Appleton, Monika Kaushik, Hazem Khout, Giuseppina Mondani, Simon Pilgrim, Tim Rattay, Shahid Gilani, Sankaran Narayanan, Soni Soumian, Megha Tandon, Phil Brookes, Henry Ferguson, Jenni Gaughan, Marlies Heitmann, Mohd Iqbal, Jane Aitken, Olubunmi Odofin, Chukwuemeka Wosu, Dibendu Betal, Riccardo Bonomi, Rachel Ainsworth, Isabella Dash, Chiara Rossi, Karen James, Raman Vinayagam, Elizabeth Baker, Amrita Chandra, Baek Kim, Kailas Munot, Rana Nasr, Jenny Piper