Multicentre prospective observational study evaluating recommendations for mastectomy by multidisciplinary teams

BACKGROUND: Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision-making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in mastectomy rates. RESULTADOS: Un total de 1.776 pacientes fueron sometidas a 1.823 mastectomias en 68 unidades. La mastectomia fue recomendada por los MDTs en 1.402 (76,9%) de estas mujeres. Las razones mas frecuentes para recomendar la mastectomia fueron la elevada proporcion entre el tamano del tumor y el de la mama (530; 29,1%) y la enfermedad multicentrica (372; 20,4%). En total, a 202 mujeres postmenopausicas con tumores unifocales positivos para receptores de estrogenos (ER+) se les recomendo la mastectomia y no se les ofrecio NST; debido a una elevada proporcion entre el tamano del tumor y de la mama en 173 (86%) pacientes. A 75 mujeres de < 70 anos con tumores positivos para el human epidermal growth factor receptor 2 (HER2+) se les recomendo la mastectomia y no se les ofrecio NST; debido a una elevada proporcion entre el tamano del tumor y de la mama en 45 (60%) mujeres. CONCLUSION: La mayoria de las mastectomias se recomendaron en casos con una elevada proporcion entre el tamano del tumor y el de la mama, pero existe una inconsistencia en la utilizacion de la NST para reducir el tamano del tumor en pacientes con grandes canceres ER+ o HER2+. La aplicacion de recomendaciones estandarizadas para la NST podria reducir el numero de mastectomia recomendadas por los MDT. RESULTS: Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76·9 per cent) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (530 women, 29·1 per cent) and multicentric disease (372, 20·4 per cent). In total, 202 postmenopausal women with oestrogen receptor-positive (ER+) unifocal tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 173 women (85·6 per cent). 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, owing to large tumour to breast size ratio in 45 women (60 per cent). CONCLUSION: Most mastectomies are advised for large tumour to breast size ratio, but there is an inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. The application of standardized recommendations for NST could reduce the number of mastectomies advised by MDTs.