Cancer Risk after Fat Transfer: A Multicenter Case-Cohort Study

Fat Transfer After Mastectomy, is it Safe?

2017 Study Abstract

Background
Fat transfer is an increasingly popular method for refining postmastectomy breast reconstructions. However, concern persists that fat transfer may promote disease recurrence. Adipocytes are derived from adipose-derived stem cells and express adipocytokines that can facilitate active breast cancer cells in laboratory models. The authors sought to evaluate the association between fat transfer to the reconstructed breast and cancer recurrence in patients diagnosed with local or regional invasive breast cancers.

Methods
A multicenter, case-cohort study was performed. Eligible patients from four centers (Memorial Sloan Kettering, M. D. Anderson Cancer Center, Alvin J. Siteman Cancer Center, and the University of Chicago) were identified by each site’s institutional tumor registry or cancer data warehouse. Eligibility criteria were as follows: mastectomy with immediate breast reconstruction between 2006 and 2011, age older than 21 years, female sex, and incident diagnosis of invasive ductal carcinoma (stage I, II, or III). Cases consisted of all recurrences during the study period, and controls consisted of a 30 percent random sample of the study population. Cox proportional hazards regression was used to evaluate for association between fat transfer and time to recurrence in bivariate and multivariate models.

Cancer Risk after Fat Transfer: A Multicenter Case-Cohort Study, AMERICAN SOCIETY OF PLASTIC SURGEONS, Plastic & Reconstructive Surgery, January 2017 – Volume 139 – Issue 1 – p 11–18, doi: 10.1097/PRS.0000000000002838.

Results
The time to disease recurrence unadjusted hazard ratio for fat transfer was 0.99 (95 percent CI, 0.56 to 1.7). After adjustment for age, body mass index, stage, HER2/Neu receptor status, and estrogen receptor status, the hazard ratio was 0.97 (95 percent CI, 0.54 to 1.8).

Conclusion
In this population of breast cancer patients who had mastectomy with immediate reconstruction, fat transfer was not associated with a higher risk of cancer recurrence.

In this video published on 29 Dec 2016 bu the PRSJournal channel, Rod J. Rohrich, MD, Editor-in-Chief of “Plastic and Reconstructive Surgery” discusses the safety of Fat Transfer after Mastectomy vs. traditional reconstruction surgery.

If screening had been a drug, it would have been withdrawn from the market

Which country will be first to stop mammography screening?

Key points

  • Screening with mammography does not reduce the occurrence of advanced cancers.
  • Rigorous observational studies in Europe have failed to find an effect of mammography screening.
  • Mammography screening produces patients with breast cancer from among healthy women and increases the number of mastectomies performed.
  • The most effective method we have to reduce the occurrence of breast cancer is to stop screening.

Time to stop mammography screening?

The Canadian Task Force on Preventive Health Care should be congratulated for its new recommendations on screening for breast cancer in women at average risk aged 40–74 years. These guidelines are more balanced and more in accordance with the evidence than any previous recommendations.

The recommendations against routine clinical breast examinations, breast self-examinations and magnetic resonance imaging to screen for breast cancer in this age and risk group are all straightforward.

The recommendations on mammography screening are even more conservative than the change in policy suggested by the US Preventive Services Task Force in 2009, which created an uproar in the United States from people interested in maintaining the status quo. The new Canadian guidelines are appropriately cautious, advising against routinely screening women aged 40–49 years. The task force recommends screening women aged 50–69 years every two to three years, although it admits that this is a weak recommendation based on moderate-quality evidence, and screening women aged 70–74 years on the same schedule based on low-quality evidence. The task force also suggests that women who do not place a high value on a small reduction in breast cancer mortality, and who are concerned with false-positive results on mammography and overdiagnosis, may decline screening.

These guidelines are an important step in the right direction, away from the prevailing attitude that a woman who does not undergo screening is irresponsible. Recent research even suggests that it may be most wise to avoid screening altogether, at any age, as outlined below.

The Canadian Task Force on Preventive Health Care decided not to include observational studies in its systematic review unless they were needed to elucidate the harms of screening or the values and preferences of patients. However, important observational studies have been published in recent years, without which a systematic review would be incomplete. These observational studies have been discussed elsewhere and have also been included in an update (currently submitted for publication) of our 2009 Cochrane review of mammography screening.

Doubtful effect of screening

Time to stop mammography screening?; National Institutes of Health PMC3225414 183(17): 1957–1958, Nov 22 2011.

Programming a latest-gen mammography station, nicoyogui.

If screening does not reduce the occurrence of advanced cancers, it does not work. A systematic review of studies from seven countries showed that, on average, the rate of malignant tumours larger than 20 millimetres was not affected by screening. Because the size of a tumour is linearly correlated to the risk of metastasis, this result is evidence against an effect of screening.

Denmark has a unique control group within its population — only 20% of its population was screened during a 17-year period. The annual decrease in breast cancer mortality in the relevant age group (55–74 years) and period was 1% in the areas with screening and 2% in the non-screened areas.Among women who were too young to benefit from screening, the decreases were larger (5% for screened areas, 6% for unscreened areas). Similar results have been reported from the United Kingdom, Sweden and Norway.

A study involving women from 30 European countries showed that the mean decrease in breast cancer mortality between 1989 and 2005 among women less than 50 years of age was 37%; the corresponding decrease was 21% among women aged 50–69 years. The declines began before the start of organized screening programs in many countries and are more likely explained by the introduction of tamoxifen. The introduction of tamoxifen could explain the larger decline seen among young women who often have estrogen-sensitive tumours.

Another study compared three pairs of similar neighbouring countries that had introduced screening 10–15 years apart. The pairs were Northern Ireland and the Republic of Ireland, the Netherlands and Belgium, and Sweden and Norway. There was no relation between start of screening and the reduction in breast cancer mortality.The fall in breast cancer mortality was about the same in all countries. Furthermore, the decline was also about the same as that seen in the United States, where screening started as early as in Sweden.

Screening seems to be ineffective in today’s world for two reasons. First, adjuvant therapy, such as tamoxifen and chemotherapy, is highly effective (even when the cancer has metastasized) but was not often used at the time of the old trials. Second, public awareness of breast cancer has increased, and women tend to see a doctor much earlier today when they have noticed something unusual in their breast. In Denmark, the average size of a tumour decreased by nine millimetres from 1979 to 1989, a reduction that occurred before screening started. In addition, this decrease was larger than the average difference in tumour size seen between screened and control groups in trials (5 mm), despite the tendency for small, overdiagnosed tumours to spuriously exaggerate the difference.

It has often been claimed that mammography screening reduces breast cancer mortality by 30%. However, thorough systematic reviews have estimated only a 15% reduction, and data on tumour size from the trials are compatible with only a 12% effect.This effect is similar to the results seen in the most reliable studies, which showed a 10% effect after 13 years.

Overdiagnosis

Any possible effect of screening on breast cancer mortality must be marginal and could be counteracted by the life-shortening effect that radio-therapy and chemotherapy have when used in healthy women in whom breast cancer has been overdiagnosed (i.e., a diagnosis of breast cancer that would not have been made in the woman’s remaining life had she not undergone screening). The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening. Compelling data from the US, Norway and Sweden show that most overdiagnosed tumours would have regressed spontaneously without treatment.  In addition, screening substantially increases the number of mastectomies performed, despite routine claims to the contrary by advocates of screening.

The best method we have to reduce the risk of breast cancer is to stop the screening program. This could reduce the risk by one-third in the screened age group, as the level of overdiagnosis in countries with organized screening programs is about 50%.

If screening had been a drug, it would have been withdrawn from the market. Thus, which country will be first to stop mammography screening?

Peter Gøtzsche, MD, 2011.

Double mastectomy after breast cancer is pointless for most women, experts find

Rates of prophylactic mastectomy have tripled in past decade despite no survival benefit

Double Mastectomy image
The latest data show that more women are removing healthy breasts to avoid cancer. But that isn’t helping them to prevent the disease or to survive longer.

Abstract

Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer, Annals of Surgery, doi: 10.1097/SLA.0000000000001698, March 8, 2016.

Objective
To update and examine national temporal trends in contralateral prophylactic mastectomy (CPM) and determine whether survival differed for invasive breast cancer patients based on hormone receptor (HR) status and age.

Methods
We identified women diagnosed with unilateral stage I to III breast cancer between 1998 and 2012 within the Surveillance, Epidemiology, and End Results registry. We compared characteristics and temporal trends between patients undergoing breast-conserving surgery, unilateral mastectomy, and CPM. We then performed Cox proportional-hazards regression to examine breast cancer-specific survival (BCSS) and overall survival (OS) in women diagnosed between 1998 and 2007, who underwent breast-conserving surgery with radiation (breast-conserving therapy), unilateral mastectomy, or CPM, with subsequent subgroup analysis stratifying by age and HR status.

Results
Of 496,488 women diagnosed with unilateral invasive breast cancer, 59.6% underwent breast-conserving surgery, 33.4% underwent unilateral mastectomy, and 7.0% underwent CPM. Overall, the proportion of women undergoing CPM increased from 3.9% in 2002 to 12.7% in 2012 (P < 0.001). Reconstructive surgery was performed in 48.3% of CPM patients compared with only 16.0% of unilateral mastectomy patients, with rates of reconstruction with CPM rising from 35.3% in 2002 to 55.4% in 2012 (P < 0.001). When compared with breast-conserving therapy, we found no significant improvement in BCSS or OS for women undergoing CPM (BCSS: HR 1.08, 95% confidence interval 1.01-1.16; OS: HR 1.08, 95% confidence interval 1.03-1.14), regardless of HR status or age.

Rates of prophylactic mastectomy have tripled in past decade despite no survival benefit, BRIGHAM AND WOMEN’S HOSPITAL, eurekalert, 11-MAR-2016.

Conclusions
The use of CPM more than tripled during the study period despite evidence suggesting no survival benefit over breast conservation. Further examination on how to optimally counsel women about surgical options is warranted.

Real-life mastectomy models wanted: join the Everyday Superwoman competition

Love beautiful mastectomy lingerie? Had breast surgery due to breast cancer? Lorna Drew needs you!

everyday-superwomen image
The UK brand launched a worldwide search for real-life mastectomy wannabe models. Any woman who has undergone breast surgery due to breast cancer can enter Lorna Drew Everyday Superwomen competition.

Lorna Drew Everyday Superwoman campaign promotes the use of relatable role models for women going through breast cancer treatment. These women share inspirational stories of their strength and present a positivity about their body image, which is reflected in the way that they live their lives. There is no such thing as “perfection” and beauty comes in many variations so we intend to celebrate it!

The UK brand aim is to show how its mastectomy lingerie will not only fit and feel perfect on a variety of women of all shapes and sizes, prosthetics and reconstructions, but it will look beautiful too! All types of breast cancer, prosthesis, reconstructions, sizes, ages, and body shapes are all encouraged to enter!

Sources and more information
  • Download your entry here and email it here.
  • About Everyday Superwomanlornadrew.
  • Competition full list of prizes.
  • Lorna Drew starts mastectomy model search, lingerieinsight, Jul 1, 2015.

Mastectomy Lingerie: discover Lorna Drew new Collection

Due to customer demand, Lorna Drew launched their first mastectomy collection in early February 2015.

Mastectomy-Collection image
One of the biggest hurdles women face after breast removal is finding a bra that works for their new body shape.
Mastectomy felt like a natural next step in expansion for the Lorna Drew brand.

Due to customer demand, Lorna Drew launched their first mastectomy collection in early February 2015. That decision I am sure, will make lots of women – dealing with breast cancer – happy.

We have seen another year of growth in sales for our maternity brand collection which got me to think about how best to move our company forward,” said the designer and brand’s namesake, Lorna Drew. “Mastectomy lingerie was something that we are continuously being asked for by our stockists. Some of them were already selling our Nursing bras to their Mastectomy customers, due to the fact that our nursing bras already had pockets in place for breast pads which were being used to fit their prosthetics instead.”

Sources and more information

Lumpectomy plus Radiotherapy as effective as Bilateral Mastectomy

Disadvantages of a bilateral mastectomy compared to a lumpectomy include a longer recovery time and a higher risk of complications.

breast cancer surgery image
Disadvantages of a bilateral mastectomy compared to a lumpectomy include a longer recovery time and a higher risk of complications.

Bilateral mastectomy does not increase breast cancer survival chances – when compared to breast-conserving surgery plus radiation, the Daily Mail, Guardian, Independent and Mirror reported yesterday.

The news is based on the results of a large US cohort study of women with early stage breast cancer in one breast.

The study found that the 10-year mortality benefit associated with double mastectomy was the same as breast-conserving surgery (also known as lumpectomy, where the cancer and a border of healthy tissue is removed) plus radiotherapy.

Unilateral mastectomy (removal of the affected breast only) was associated with higher mortality than were the other 2 surgical options, although the absolute difference was only 4%.

Sources and More Information:

  • Lumpectomy as effective as double mastectomy, NHS Choices, Cancer, September 3 2014.
  • Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011, JAMA. 1900512 2014;312(9):902-914. doi:10.1001/jama.2014.10707.

Most Women (60%) who have Mastectomy do not get Breast Reconstruction

Breast reconstruction after a mastectomy has long been an option, but a new study shows that only about 42% of women choose it

JAMA surgery background image
Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making

Breast reconstruction after a mastectomy has long been an option, but a new study shows that only about 42 percent of women choose it.

The goal of the study was to look at how many women had the reconstruction, why some decided against it, and whether they were satisfied with their decision.

Abstract

Importance
Most women undergoing mastectomy for breast cancer do not undergo breast reconstruction.

Objective
To examine correlates of breast reconstruction after mastectomy and to determine if a significant unmet need for reconstruction exists.

Design, Setting, and Participants
We used Surveillance, Epidemiology, and End Results registries from Los Angeles, California, and Detroit, Michigan, for rapid case ascertainment to identify a sample of women aged 20 to 79 years diagnosed as having ductal carcinoma in situ or stages I to III invasive breast cancer. Black and Latina women were oversampled to ensure adequate representation of racial/ethnic minorities. Eligible participants were able to complete a survey in English or Spanish. Of 3252 women sent the initial survey a median of 9 months after diagnosis, 2290 completed it. Those who remained disease free were surveyed 4 years later to determine the frequency of immediate and delayed reconstruction and patient attitudes toward the procedure; 1536 completed the follow-up survey. The 485 who remained disease free at follow-up underwent analysis.

Exposures
Disease-free survival of breast cancer.

Main Outcomes and Measures
Breast reconstruction at any time after mastectomy and patient satisfaction with different aspects of the reconstruction decision-making process.

Results
Response rates in the initial and follow-up surveys were 73.1% and 67.7%, respectively (overall, 49.4%). Of 485 patients reporting mastectomy at the initial survey and remaining disease free, 24.8% underwent immediate and 16.8% underwent delayed reconstruction (total, 41.6%). Factors significantly associated with not undergoing reconstruction were black race (adjusted odds ratio [AOR], 2.16 [95% CI, 1.11-4.20]; P = .004), lower educational level (AOR, 4.49 [95% CI, 2.31-8.72]; P < .001), increased age (AOR in 10-year increments, 2.53 [95% CI, 1.77-3.61]; P < .001), major comorbidity (AOR, 2.27 [95% CI, 1.01-5.11]; P = .048), and chemotherapy (AOR, 1.82 [95% CI, 0.99-3.31]; P = .05). Only 13.3% of women were dissatisfied with the reconstruction decision-making process, but dissatisfaction was higher among nonwhite patients in the sample (AOR, 2.87 [95% CI, 1.27-6.51]; P = .03). The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery (48.5%) and the belief that it was not important (33.8%), but 36.3% expressed fear of implants. Reasons for avoiding reconstruction and systems barriers to care varied by race; barriers were more common among nonwhite participants. Residual demand for reconstruction at 4 years was low, with only 30 of 263 who did not undergo reconstruction still considering the procedure.

Conclusions and Relevance
Reconstruction rates largely reflect patient demand; most patients are satisfied with the decision-making process about reconstruction. Specific approaches are needed to address lingering patient-level and system factors with a negative effect on reconstruction among minority women.

More Information:

  • Many Women Who Have Mastectomy Don’t Get Breast Reconstruction: Study, NewsHealth, August 20, 2014.
  • Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making, JAMA Surgery, articleid=1893807, August 20, 2014.

Breast Cancer Survival Rates : Removing Healthy Breast of very Little Benefit if any…

Prophylactic Mastectomy does Little to Improve Breast Cancer Survival Rate

There may be little to no survival benefit for most women with breast cancer to have their healthy breast removed as well, new research indicates.

Many women with cancer in one breast have been electing to have the second breast removed (prophylactic mastectomy) out of precaution, but this new study finds that over 20 years, the survival benefit between women who’ve had a the second breast removed and those who kept their healthy breast was less than 1 percent, HealthDay reported.

We found fairly convincing evidence that there really is no meaningful long-term survival benefit for the vast majority of women with breast cancer by having their opposite breast removed,” study researcher Dr. Todd Tuttle told HealthDay. Tuttle, the chief of surgical oncology at the University of Minnesota School of Medicine, said the research shows that most patients have very minimal increases in life expectancy (1-7 months) by choosing to have the second breast removed.

Prophylactic mastectomy : the survival difference between those who had the surgery and those who didn’t was still less than 1 percent over 20 years, the study found.

Younger women with stage I, estrogen receptor-negative breast cancer saw the biggest increase in survival rate from having the second breast removed, but even that was minimal. The survival difference between those who had the surgery and those who didn’t was still less than 1 percent over 20 years, the study found.

The study, published in JNCI: Journal of the National Cancer Institute, did not include women who had BRCA-1 and BRCA-2 breast cancer. According to HealthDay, these genes greatly increase a woman’s risk of breast and ovarian cancer. Because of this increased risk, women are often offered preventive surgeries to remove the breasts and the ovaries.

For the study, researchers analyzed more than 100,000 women with stage I or stage II breast cancer to track survival over 20 years. Tuttle’s team then used a model to simulate survival results in women who had prophylactic mastectomy and those who did not, HealthDay reported.

Other factors, such as surgical complications or quality of life were not taken into account. Previous studies have suggested that women’s motives for having the second breast remove revolve around fear of the cancer spreading. One study of women age 40 and under with breast cancer who chose preventive mastectomy found that 94 percent of the women said they wanted to increase survival, yet only 18 percent thought the procedure would actually do that, HealthDay reported.

Tuttle said women who have the procedure for a peace of mind are giving themselves a false sense of security. He said that while women who have had breast cancer in one breast are at increased risk of developing cancer in the opposite breast, the probability of developing cancer in the second breast is about 4 or 5 percent over the next 10 years, HealthDay reported.

Sources and More Information

  • Prophylactic Mastectomy does Little to Improve Breast Cancer Survival Rate, SideEffectsLawSuitsNews, archives, July 18th, 2014.
  • Removing Healthy Breast of Little Benefit to Breast Cancer Patients: Study, HealthDay, breast-cancer-news-94, Jul 16, 2014.
  • Marginal Survival Benefit After Contralateral Prophylactic Mastectomy, Medscape Medical News Oncology, viewarticle/828411, July 16, 2014.
  • The harms and benefits of modern screening mammography, BMJ 2014; 348:g3824, 17 June 2014.
  • Survival Outcomes After Contralateral Prophylactic Mastectomy: A Decision Analysis, Oxford JournalsMedicine & Health JNCI J Natl Cancer Inst Volume 106, Issue 810.1093/jnci/dju160 – Full PDF – May 12, 2014.
  • Assessing Mammography’s Benefits and Harms, Oxford JournalsMedicine & Health JNCI J Natl Cancer Inst Volume 106, Issue 410.1093/jnci/dju103, March 31, 2014.
  • Perceptions of contralateral breast cancer: an overestimation of risk, NCBI, Dr. Todd Tuttle, PMID: 21947590, 2011 Oct;18.

Breast Cancer: increased Survival Rates with Breast-Conserving Surgery versus Radical Mastectomy

Breast-conserving surgery led to improved cancer-specific survival in early breast cancer as compared with mastectomy, with or without radiation therapy

U of U Health Care logo
The University of Utah aims to provide the best possible care, discover better treatments and train tomorrow’s health care experts.

Breast-conserving surgery led to improved cancer-specific survival in early breast cancer as compared with mastectomy, with or without radiation therapy, a large retrospective review showed.

Patients treated with breast conservation had significantly higher 5- and 10-year survival, including an 11% absolute difference from mastectomy plus radiation therapy at 10 years, according to researchers of the University of Utah.

Sources and Articles
  • Breast-Sparing Tops Mastectomy in New Analysis, MedPageToday, 20 Mar 2014
  • Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer, JAMA Surg. 1813803 2014;149(3):267-274. doi:10.1001/jamasurg.2013.3049.
  • Breast-Conserving Therapy for Triple-Negative Breast Cancer, JAMA Surg. 1793208 2014;149(3):252-258. doi:10.1001/jamasurg.2013.3037.
  • Breast-Conserving Therapy: A Viable Option for Young Women with Early Breast Cancer-Evidence from a Prospective Study, NCBI, PMID: 24599412, 2014 Mar 6
Abstract

BACKGROUND:
This study evaluated the security of breast-conserving treatment (BCT) in young patients and the effect of regional radiation therapy on young patients with 1-3 positive nodes (N+) treated with BCT.
METHODS:
In this prospective concurrent controlled study, 164 patients were defined as the BCT group, and regional radiation therapy was delivered to patients with 1-3 N+. Modified radical mastectomies (MRMs) were performed on 224 patients without regional radiation therapy.
RESULTS:
The 9-year local recurrence (LR) rate of the BCT was 7 %, compared with 3 % in the MRM group (p = 0.055). The 9-year regional recurrence (RR) rate was 6 % for the BCT group and 12 % for the MRM group (p = 0.048). The distant metastasis (DM)-free and breast cancer-specific survival rates were similar between the two groups. RR was an independent prognostic factor for DM [hazard ratio 3.27; 95 % confidence interval (CI) 1.726-6.208] and breast cancer-specific survival (hazard ratio 5.814; 95 % CI 2.690-12.568), whereas LR was not an independent prognostic factor for DM or breast cancer-specific survival.
CONCLUSIONS:
Young patients treated with BCT have a higher LR rate than that of MRM. However, LR has no detrimental effect on DM-free and breast cancer-specific survival rates, whereas RR is a strong risk factor of DM and death. Regional radiation therapy for young patients with 1-3 N+ may reduce RR and improve survival rates.

What is the Saatchi Bill and do we need it?

Lord Saatchi’s Medical Innovation Bill “the SaatchiBill” would help doctors innovate new treatments and cures for cancer and other diseases

Lord Saatchi’s Medical Innovation Bill “the Saatchi Bill” will help doctors innovate new treatments and cures for cancer and other diseases.

The Medical Innovation Bill will save lives by supporting doctors who want to innovate and find new ways of treating disease.

Doctors, patients and judges will have much greater clarity as to what is negligent and dangerous practice by clinicians and what is careful and sensible innovation.

It will free your doctor to consider new treatments and ideas. But, and more importantly, it will allow the patient to demand innovative treatment.

What is the Saatchi Bill and why do we need it?
What is the Saatchi Bill and why do we need it? Follow @SaatchiBill #Cancer

One of the most famous examples of innovation is when Geoffrey Keynes, a doctor at Barts, refused to do what surgeons across the UK and US were doing with breast cancer – the Halsted method – whereby women with breast cancer faced a double mastectomy, and the removal of all tissue from the shoulder, to the chest wall, to ribs – anything and everything that could be removed without killing the women.

Keynes, alone, removed only the tumour and undertook radiotherapy, in combination. He was ridiculed and humiliated on a world stage. Halsted followers called it a ‘lumpectomy’ as a term of derision. Of course, today, the lumpectomy is standard procedure.

That was innovation.

Once passed, a patient, armed with the legislation, will be able to say to his or her doctor: ‘Are you trying everything? Can you do anything differently?’ The doctor will no longer need to say he or she cannot risk trying anything new.  ”

Sources:

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