scholarly journals Oncoplastic and reconstructive breast surgery in Canada: breaking new ground in general surgical training

2018 ◽  
pp. 294-299
Author(s):  
Lashan Peiris ◽  
David Olson ◽  
Kelly Dabbs
Keyword(s):  
Breast Cancer ◽  
Surgical Training ◽  
Breast Surgery ◽  
Fellowship Training ◽  
Immediate Breast Reconstruction ◽  
Oncoplastic Breast Surgery ◽  
The Uk

Oncoplastic breast surgery combines certain plastic surgery procedures with a breast cancer resection to minimize the cosmetic penalty. We compared current practices in breast surgery in Canada and the UK, looking at the classification of oncoplastic breast surgery, management of larger tumours that would otherwise mandate a mastectomy, and the breast surgeon’s role in immediate breast reconstruction. Reconstructive breast surgery has always fallen within the domain of the plastic surgeon, but surgical subspecialization and more focused fellowship training have meant that breast surgeons with the appropriate skillset can offer these procedures. This evolution of the breast surgeon has led to the birth of a new field of breast surgery known as oncoplastic and reconstructive breast surgery. Those tasked with developing surgical training programs in Canada must now decide whether to train breast surgeons in these techniques to improve long-term quality of life among Canadian patients with breast cancer.

scholarly journals From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmad Kaviani ◽  
Nassim Sodagari ◽  
Sara Sheikhbahaei ◽  
Vahid Eslami ◽  
Nima Hafezi-Nejad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Radical Mastectomy ◽  
Breast Conserving Therapy ◽  
Cosmetic Outcome ◽  
Health Economy ◽  
Outcome Quality ◽  
Oncoplastic Breast Surgery ◽  
Oncological Result

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

scholarly journals Education and Training in Breast Cancer Surgery in Europe

Breast Care ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. 366-372
Author(s):  
Lynda Wyld ◽  
Isabel T. Rubio ◽  
Tibor Kovacs
Keyword(s):  
Breast Cancer ◽  
New Zealand ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Specialist Training ◽  
Member States ◽  
The Usa ◽  
The Uk

Background: The substantial increase in the complexity of breast cancer care in the last few decades has resulted in significant improvements in survival rates and also in the quality of life of breast cancer survivors. However, across Europe there are variations in outcomes and access to the latest techniques. Whilst much of this variance is due to differences in health economies between European member states, training variation may also play a part. Training in breast cancer surgery varies greatly across Europe, not only in its basal discipline (general surgery, gynaecology or plastic surgery) but also in the length of training and whether there is any requirement for specialist training. Several countries have been leading the way in training breast specialist surgeons (the USA, the UK, Australia and New Zealand) with dedicated 1- or 2-year fellowships either within or in addition to standard training. Access to such training is limited and consequently many women in Europe are still treated by generalists, potentially denying them access to the best care. This paper reviews the issues surrounding training provision in breast surgery and some of the challenges which need to be addressed to improve the current situation. Summary: Breast surgery training in Europe is of variable quality and duration, which may result in variations in the quality of care received by patients with breast cancer. Specialist training standards are urgently required which should be adopted by all European member states. Excellent models are available in the USA, the UK and Australia and New Zealand on which to base this training. Key Messages: The quality of training in breast surgery needs to be upgraded and harmonised across Europe.

scholarly journals The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mads G. Jørgensen ◽  
Navid M. Toyserkani ◽  
Frederik G. Hansen ◽  
Anette Bygum ◽  
Jens A. Sørensen
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Treatment ◽  
Breast Cancer Treatment ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Impact

AbstractThe impact of breast cancer-related lymphedema (BCRL) on long-term quality of life is unknown. The aim of this study was to investigate the impact of BCRL on health-related quality of life (HRQoL) up to 10 years after breast cancer treatment. This regional population-based study enrolled patients treated for breast cancer with axillary lymph node dissection between January 1st 2007 and December 31th 2017. Follow up and assessments of the included patients were conducted between January 2019 and May 2020. The study outcome was HRQoL, evaluated with the Lymphedema Functioning, Disability and Health Questionnaire, the Disabilities of the Arm, Shoulder and Hand Questionnaire and the Short Form (36) Health Survey Questionnaire. Multivariate linear logistic regression models adjusted for confounders provided mean score differences (MDs) with 95% confidence intervals in each HRQoL scale and item. This study enrolled 244 patients with BCRL and 823 patients without BCRL. Patients with BCRL had significantly poorer HRQoL than patients without BCRL in 16 out of 18 HRQoL subscales, for example, in physical function (MDs 27, 95%CI: 24; 30), mental health (MDs 24, 95%CI: 21; 27) and social role functioning (MDs 20, 95%CI: 17; 23). Age, BMI, BCRL severity, hand and dominant arm affection had only minor impact on HRQoL (MDs < 5), suggesting a high degree of inter-individual variation in coping with lymphedema. This study showed that BCRL is associated with long-term impairments in HRQoL, especially affecting the physical and psychosocial domains. Surprisingly, BCRL diagnosis rather than clinical severity drove the largest impairments in HRQoL.

scholarly journals Towards a hydrological classification of European soils: preliminary test of its predictive power for the base flow index using river discharge data

2007 ◽  
Vol 11 (4) ◽  
pp. 1501-1513 ◽  
Author(s):  
M. K. Schneider ◽  
F. Brunner ◽  
J. M. Hollis ◽  
C. Stamm
Keyword(s):  
Water Movement ◽  
Base Flow ◽  
Regression Coefficients ◽  
Northern Europe ◽  
Flow Index ◽  
Discharge Data ◽  
Base Flow Index ◽  
The Uk

Abstract. Predicting discharge in ungauged catchments or contaminant movement through soil requires knowledge of the distribution and spatial heterogeneity of hydrological soil properties. Because hydrological soil information is not available at a European scale, we reclassified the Soil Geographical Database of Europe (SGDBE) at 1:1 million in a hydrological manner by adopting the Hydrology Of Soil Types (HOST) system developed in the UK. The HOST classification describes dominant pathways of water movement through soil and was related to the base flow index (BFI) of a catchment (the long-term proportion of base flow on total stream flow). In the original UK study, a linear regression of the coverage of HOST classes in a catchment explained 79% of BFI variability. We found that a hydrological soil classification can be built based on the information present in the SGDBE. The reclassified SGDBE and the regression coefficients from the original UK study were used to predict BFIs for 103 catchments spread throughout Europe. The predicted BFI explained around 65% of the variability in measured BFI in catchments in Northern Europe, but the explained variance decreased from North to South. We therefore estimated new regression coefficients from the European discharge data and found that these were qualitatively similar to the original estimates from the UK. This suggests little variation across Europe in the hydrological effect of particular HOST classes, but decreasing influence of soil on BFI towards Southern Europe. Our preliminary study showed that pedological information is useful for characterising soil hydrology within Europe and the long-term discharge regime of catchments in Northern Europe. Based on these results, we draft a roadmap for a refined hydrological classification of European soils.

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