Breast Cancer Surgery

Top 10 priorities

1. Can complete lymph node removal (axillary clearance) be avoided in patients with spread of cancer to the armpit (axilla); what are the alternatives and the outcomes of this approach?
2. What factors increase the risk of breast cancer returning; Is it possible to predict which patients are at higher risk to help them make a more informed decision about breast cancer surgery?
3. Are minimally invasive, image-guided techniques (e.g. vacuum excision or freezing) to remove or destroy the breast cancer a safe and effective alternative to breast cancer surgery?
4. In patients having breast chemotherapy before surgery, what is the best way of monitoring the cancer and is it possible to tell whether the cancer has completely responded to treatment without performing an operation? How long, if at all, after finishing chemotherapy should an operation be performed?
5. What is the best management of ductal carcinoma in situ (pre-invasive breast cancer) and how is this influenced by tumour and patient characteristics (e.g. patient age, hormone receptor status)?
6. Are there some low-risk breast cancers or lesions detected by breast screening that do not need treatment at all and how it possible to work out which ones these are?
7. How does a breast cancer diagnosis impact on patients’ wellbeing? What information and support do patients want around the time of diagnosis, during and after treatment, and what are the best methods to individualise this?
8. What are the outcomes of mastectomy with and without breast reconstruction; how should these be discussed with patients so that they have realistic expectations of outcomes and can make informed decisions?
9. What is the best method of follow up imaging to detect whether the cancer has returned following breast cancer surgery and how is this influenced by tumour and patient characteristics (e.g. patient age, hormone receptor status)?
10. What is the impact of mastectomy with or without breast reconstruction on quality of life for women at high risk of breast cancer, and when and/or at what age should surgery be performed?

The following questions were also discussed and put in order of priority at the workshop:

11. What is the best way to ensure that patients can make fully informed choices about their breast cancer surgery options, feel involved in the process, and have sufficient time to make their decisions?
12. Can new technologies be used to predict whether a breast cancer has been completely removed at the time of surgery to reduce the need for a second operation?
13. How can women at high-risk of breast cancer be best supported before, during and after risk reduction surgery? (Breast surgery to reduce the risk of breast cancer)
14. What is the best way to treat the axillary (armpit) lymph nodes in patients with breast cancer who have had chemotherapy before surgery?
15. What are the outcomes of mastectomy after breast cancer and can better surgical techniques be used to improve the appearance of the chest wall?
16. What are the outcomes of mastectomy for symmetry in women with breast cancer but with no additional genetic risk? When should this be performed and how can women’s decision-making be best supported?
17. Can mastectomy be safely avoided in patients with more than one breast cancer in different parts of the same breast?
18. When is balancing surgery required to the other breast, and should it be performed at the same time as the breast cancer surgery or later?

Key documents

Breast Cancer Surgery PSP protocol

Breast Cancer Surgery PSP Steering Group terms of reference

Breast Cancer Surgery PSP question verification form

Breast Cancer Surgery PSP engagement summary