Early breast cancer treatment in China remains conservative

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By: scienterrific | Last updated: 23 September 2018 | In: China, Breast Cancer, Oncology, Chemotherapy, Surgery

Article Keywords

neoadjuvant, ALND, BCS, breast conserving surgery, DCIS, EBC, lumpectomy, NACT, SLNB, mastectomy

Breast-conserving surgery (BCS) is uncommon in China, and despite routinely performing sentinel lymph node biopsies (SLNB) the uptake of the American College of Surgeons Oncology Group (ACOSOG) Z0011 study recommendation to treat selected sentinel node-positive patients with whole breast irradiation and adjuvant systemic therapy instead of axillary lymph node dissection (ALND) remains low at only 17% of Chinese centres. These were the key findings of a national survey among 520 Chinese hospitals.

“Chinese doctors need to catch up with the updated results of the cutting-edge clinical studies and multiple measures are in need to improve this situation.”

Recent data from China suggests an increase in early-stage breast cancer (EBC); clinical Stage I and II breast cancer now accounts for 60.6% of all cases in China. The national survey explored the surgical management patterns for EBC in China. Of the 520 surveyed hospitals, 221 (43%) responded, and 97% completed at least 70% of the questionnaire.

Preoperative pathological diagnosis in >90% of patients was found to be only performed in 26% of centres. Although core-needle biopsy was reported as the most utilised technique for both BI-RADS 1-3 (32%) and BI-RADS 4-5 (54%) groups, the survey revealed that diagnostic open excisional biopsy is still common practice; BI-RADS 1-3 patients (24%) and BI-RADS 4-5 patients (23%).

Breast-conserving surgery (BCS) remains uncommon in China. Nearly 10% of hospitals reported to never perform BCS, mostly due to lack of a skilled surgeon for the technique (1%), patient-refusal (4%), no radiotherapy department in the hospital (2%) or lack of a pathology department (1%). Only 7% and 17% of hospitals had a >50% BCS-rate for primary invasive ductal carcinoma and ductal carcinoma in situ (DCIS), respectively.

The vast majority of centres (97%; 195/201) said to use intraoperative techniques for assessment of the margin status during BCS. Cavity margin assessment was reported by 37% of the respondents. Intraoperative frozen sections were utilised for diagnostic purpose in 87% of hospitals, and 31% performed both. Almost 43% of respondents defined an adequate margin as at least 10 mm of clear tissue for invasive carcinomas; 15% felt that no tumour cells on the ink was sufficient for invasive cancers. For DCIS, 21% of respondents believed no tumour on the ink to be adequate.

Where 8% of the respondents would consider to re-excise the whole cavity again, 90% answered that they would re-excise only the focal area with the positive intraoperative margin. Respondents were more likely to “always” recommend re-excision for severe atypical hyperplasia (37%) when compared to than mild-moderate hyperplasia (11%).

Sentinal lymph node biopsies are commonly performed in Chinese hospitals (93%); 48% of hospitals carried SLNB out after neoadjuvant chemotherapy (NACT) whereas 43% would perform an SLNB before NACT. Most centres (78%) would stain using dye only (most common: methylene blue [81%]), the remainder 22% used both dye and radiotracer. Immunohistochemistry stains were reported by 79% of sites.

Reference

Zhang X and Wang Y. Oncoscience 2018; doi: 10.18632/oncoscience.445

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This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).

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