An analysis published in the British Journal of Surgery suggests many mastectomies in the UK might be avoided if multidisciplinary teams (MDTs) used standard recommendations for hormone therapy or chemotherapy before breast cancer surgery.
To describe current practice in MDT decision-making for recommending mastectomy, the multicentre prospective observational study recruited consecutive patients undergoing mastectomy between 1 June 2015 and 29 February 2016 at participating units across the UK. Details of neoadjuvant systemic treatment (NST), operative and oncological data and rationale for recommending mastectomy by MDTs were collected.
Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76.9%) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (29.1%) and multicentric disease (20.4%).
In total, 202 post-menopausal women with oestrogen receptor-positive (ER+) unifocal tumours were advised mastectomy and not offered NST. Seventy-five women aged less than 70 years with human epidermal growth factor receptor 2-positive (HER2+) tumours were advised mastectomy and not offered NST.
The authors concluded that most mastectomies are advised for large tumour to breast size ratio, but there is inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. They suggest the application of standardised recommendations for NST could reduce the number of mastectomies advised by MDTs.
