Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer - a classification tree approach.
Martin MA, Meyricke R, O’Neill T, Roberts S.
ABSTRACT: BACKGROUND: A critical choice facing breast cancer patients is which surgical treatment - mastectomy or breast conserving surgery (BCS) - is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of propensity is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. METHODS: Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects treatment preferences were predicted from covariates using both classification trees and logistic regression. RESULTS: Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. CONCLUSIONS: Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians advice to patients.
This article discusses what factors impacted the choice of surgical treatment. The conclusion was that tumor size was the primary factor.
This information might be helpful to a woman who was deciding about what type of surgery to choose.
Here is the abstract for the second study:
Lumpectomy vs oncoplastic surgery for breast-conserving therapy of cancer. A prospective study about 99 patients.
[Article in French]
Giacalone PL, Roger P, Dubon O, El Gareh N, Daures JP, Laffargue F.
Service de gynecologie-obstetrique, unite de chirurgie oncologique et mammaire, hopital Arnaud-de-Villeneuve, 371, rue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France.
The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. Aim of the study. - This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. Patients and methods. - Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. Results. - The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. Conclusions. - The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma, achieves accurate tumour resection, and reduces the need for further surgery.