Abstract:
PURPOSE:Unilateral mastectomy (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. Numerous etiological factors for this rise have been suggested, including increasing use of magnetic resonance imaging (MRI) and reconstruction, surgeon's preference, and patient's choice. We conducted a qualitative study to explore what role the surgeon and their practice environment play in the increasing rates. METHODS:Semi-structured interviews were conducted with general surgeons to explore their current approach to treating ESBC and their experience with women requesting mastectomy. Purposive sampling identified surgeons across Ontario, Canada, and the United States (US). Constant comparative analysis identified key concepts. RESULTS:Data saturation was achieved after 45 interviews. 'The effect of external factors on rising mastectomy rates' was the dominant theme. All surgeons described increasing mastectomy rates over the last 5 years, and all surgeons discussed breast-conserving therapy (BCT) and UM as equivalent options. However, US surgeons discussed reconstruction early in the consultation process, reflecting legislative requirements. In contrast, Ontario surgeons discussed reconstruction only when a patient was considering mastectomy. Ontario surgeons often recommended BCT, whereas US surgeons rarely made a direct recommendation regarding the extent of surgery. Neither US nor Canadian surgeons recommended the use of UM + CPM in average-risk ESBC, and all surgeons described women initiating this request. MRI use and access to immediate breast reconstruction also impacted the choice for mastectomy. CONCLUSIONS:Use of MRI, access to reconstruction, and legislative requirements regarding information disclosure, appeared to influence the surgical consultation process and the patient's request for CPM.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Covelli AM,Baxter NN,Fitch MI,Wright FCdoi
10.1245/s10434-014-3955-4subject
Has Abstractpub_date
2014-10-01 00:00:00pages
3173-84issue
10eissn
1068-9265issn
1534-4681journal_volume
21pub_type
杂志文章abstract:BACKGROUND:Locoregional therapy treatments for hepatic adenoma (HA) are typically limited to selective hepatic arterial embolization (HAE) to control acute hemorrhage. This systematic review sought to report the utilization of HAE and ablation for non-emergent treatment of HA. METHODS:A PubMed query identified studies...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-018-6802-1
更新日期:2019-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,评审
doi:10.1245/s10434-007-9485-6
更新日期:2007-11-01 00:00:00
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journal_title:Annals of surgical oncology
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abstract:BACKGROUND:Primary breast cancers that overexpress human epidermal growth factor receptor 2 have variable biological features and clinical outcomes. A subgroup of HER2-overexpressing tumors that express basal-like immunohistochemical markers-the so-called basal-HER2+ subtype--is associated with poor prognosis. We inves...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2012-03-01 00:00:00
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更新日期:2005-04-01 00:00:00
abstract:: ...
journal_title:Annals of surgical oncology
pub_type: 评论,杂志文章
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更新日期:2018-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 临床试验,杂志文章
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更新日期:2014-07-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2002-03-01 00:00:00
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journal_title:Annals of surgical oncology
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更新日期:2008-05-01 00:00:00
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journal_title:Annals of surgical oncology
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更新日期:2011-12-01 00:00:00
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journal_title:Annals of surgical oncology
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更新日期:2008-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2014-06-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,评审
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更新日期:2015-10-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:1999-07-01 00:00:00
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更新日期:2009-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1245/s10434-015-4563-7
更新日期:2015-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07675-3
更新日期:2020-02-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3771-x
更新日期:2014-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2008-06-01 00:00:00
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更新日期:2006-11-01 00:00:00
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更新日期:2008-12-01 00:00:00
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更新日期:2014-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2016-12-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,随机对照试验
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2019-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:1995-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2020-12-03 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2015-12-01 00:00:00