Cargando…

The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions

Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many...

Descripción completa

Detalles Bibliográficos
Autores principales: Pfob, André, Dubsky, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982288/
https://www.ncbi.nlm.nih.gov/pubmed/36669994
http://dx.doi.org/10.1016/j.breast.2023.01.008
_version_ 1784900298054041600
author Pfob, André
Dubsky, Peter
author_facet Pfob, André
Dubsky, Peter
author_sort Pfob, André
collection PubMed
description Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many years, the rate of BCT worldwide varies largely and its potential is still underused. While the rate of BCT in western countries has increased over the past decades to currently about 70%, the rate of BCT is as low as 10% in other countries. In this review, we will evaluate the underused potential of breast conservation after NAST, identify causes, and discuss possible solutions. We identified clinical and non-clinical causes for the underuse of BCT after NAST including uncertainties within the community regarding oncologic outcomes, the correct tumor localization after NAST, the management of multifocal and multicentric tumors, margin assessment, disparities of socio-economic aspects on a patient and national level, and psychological biases affecting the shared decision-making process between patients and clinicians. Possible solutions to mitigate the underuse of BCT after NAST include interdisciplinary teams that keep the whole patient pathway in mind, optimized treatment counseling and shared decision-making, and targeted financial support to alleviate disparities.
format Online
Article
Text
id pubmed-9982288
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-99822882023-03-04 The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions Pfob, André Dubsky, Peter Breast Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many years, the rate of BCT worldwide varies largely and its potential is still underused. While the rate of BCT in western countries has increased over the past decades to currently about 70%, the rate of BCT is as low as 10% in other countries. In this review, we will evaluate the underused potential of breast conservation after NAST, identify causes, and discuss possible solutions. We identified clinical and non-clinical causes for the underuse of BCT after NAST including uncertainties within the community regarding oncologic outcomes, the correct tumor localization after NAST, the management of multifocal and multicentric tumors, margin assessment, disparities of socio-economic aspects on a patient and national level, and psychological biases affecting the shared decision-making process between patients and clinicians. Possible solutions to mitigate the underuse of BCT after NAST include interdisciplinary teams that keep the whole patient pathway in mind, optimized treatment counseling and shared decision-making, and targeted financial support to alleviate disparities. Elsevier 2023-01-17 /pmc/articles/PMC9982288/ /pubmed/36669994 http://dx.doi.org/10.1016/j.breast.2023.01.008 Text en © 2023 The Authors. Published by Elsevier Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka
Pfob, André
Dubsky, Peter
The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title_full The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title_fullStr The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title_full_unstemmed The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title_short The underused potential of breast conserving therapy after neoadjuvant system treatment – Causes and solutions
title_sort underused potential of breast conserving therapy after neoadjuvant system treatment – causes and solutions
topic Article(s) from the Special Issue on: De-escalation of loco-regional treatment; Edited by Oreste Gentilini, Philip Poortmans, Maria João Cardoso, Elzbieta Senkus-Konefka
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982288/
https://www.ncbi.nlm.nih.gov/pubmed/36669994
http://dx.doi.org/10.1016/j.breast.2023.01.008
work_keys_str_mv AT pfobandre theunderusedpotentialofbreastconservingtherapyafterneoadjuvantsystemtreatmentcausesandsolutions
AT dubskypeter theunderusedpotentialofbreastconservingtherapyafterneoadjuvantsystemtreatmentcausesandsolutions
AT pfobandre underusedpotentialofbreastconservingtherapyafterneoadjuvantsystemtreatmentcausesandsolutions
AT dubskypeter underusedpotentialofbreastconservingtherapyafterneoadjuvantsystemtreatmentcausesandsolutions