A Statistical Modelling Approach for Guiding the Optimum Surgical Intervention of Breast Cancer
Breast cancer is most common tumour diagnosis for women worldwide. Over the last almost 40 years widespread adoption of mammographic screening has established Breast Conserving Surgery (BCS) followed by irradiation as the most practised treatment of choice. However, in absence of tools to determine the optimal quantum of tissue to be excised the debate continues for achieving a balance between the effectiveness of surgical intervention and the later stage personalisation of treatment, and so, a wide variation in practice is a common phenomenon globally. We attempt to introduce a definite measure that determines efficacy of BCS while protecting aesthetic value of life for Women affected with breast cancer.
74 mammography examinations and the surgical interventions of those women underwent for the management of breast cancer were used to compute the coefficient of lesion. In first step the lesion and the mammary gland proper are measured applying geometry. In the second step volume of tissue mass to be removed was calculated taking into account the measures from the 1st step and we present the coefficient of lesion mathematically. We empirically illustrated our methodological approach for determining the tissue mass to be excised.
Conventionally, it is assumed that if the volume of tissues to be removed does not exceed 25% of the volume of the mammary gland, a Breast Conserving Surgery, is performed, however, our empirical illustration demonstrated that the established decision making parameter is not tenable for determining the extent / type of surgery undertaken.
We have developed a coefficient aligned with the stage of the carcinoma and founded the base for developing a statistical (mathematical) model. Application of such a model accommodating tumour biology and patient characteristics shall not only provide intraoperative real time information to surgeons but also predict the prognosis of optimal surgical intervention of breast cancer.
The next step is to develop a model using the data of the mammographic examination and the coefficient of breast lesion as covariates for determining the potentially effective volumes of surgical intervention needed, and plan reconstructive measures considering the effect of time on such intervention.
Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). Estimates of worldwide burden of cancer in 2008. GLOBOCAN 2008. International Journal of Cancer, 127, 2893–2917.
Thompson, A. M., & Moulder-Thompson, S. L. (2012). Neoadjuvant treatment of breast cancer. Annals of Oncology, 23, x231–x236.
Lipkus, I. M., Peters, E., Kimmick, G., Liotcheva, V., & Marcom, P. (2010). Breast cancer patients’ treatment expectations after exposure to the decision aid program adjuvant online: the influence of numeracy. Medical Decision Making, 30, 464–473.
Singletary, S. E. (2002). Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. The American Journal of Surgery, 184, 383–393.
Morrow, M., Harris, J. R., & Schnitt, J. S. (2012). Surgical Margins in Lumpectomy for Breast Cancer – Bigger Is Not Better. The New England Journal of Medicine, 367(1), 79–82.
Morrow, M., White, J., Moughan, J., Owen, J., Pajack, T., Sylvester, J. et al. (2001). Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. Journal of Clinical Oncology, 19(8), 2254–2262.
Fleissig, A., Fallowfield, L. J., Langridge, C. I., Johnson, L., Newcombe, R. G., Dixon, J. M., et al. (2006). Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Research and Treatment, 95, 279–293.
Gregory, E. E., Turnbull, A. K., Arthur, L. M., Thomas, J., Dodds, C., & Dixon, J. M. (2017). Margin width and local recurrence after breast conserving surgery for ductal carcinoma in situ. European Journal of Surgical Oncology, 43, 2029–2035.
Chiappa, C., Rovera, F., Corben, D. A., Fachinetti, A., Berardinis, V. D., Marchionini, V., et al. (2013). Surgical margins in breast conservation. International Journal of Surgery, 11 (S1), S69–S72.
Dunst, J., & Dellas, K. (2011). Margins! Margins. Margins? How Important Is Margin Status in Breast-Preserving Therapy? Breast Care, 6, 359–362.
Azu, M., Abrahamse, P., Katz, S.J., Jagsi, R., & Morrow, M. (2010). What is an Adequate Margin for Breast-Conserving Surgery? Surgeon Attitudes and Correlates. Annals of Surgical Oncology, 17 (2), 558–563.
Blair, S.L., Thompson, K., Rococco, J., Malcarne, V., Beitsch, P.D., & Ollila, D.W. (2009). Attaining Negative Margins in Breast-Conservation Operations: Is There a Consensus among Breast Surgeons? Journal of American College of Surgeons, 209 (5), 608–613.
Coates, P. J., Appleyard, M. V., Murray, K., Ackland, C., Gardner, J., Brown, D. C., et al. (2010). Differential contextual responses of normal human breast epithelium to ionizing radiation in a mouse xenograft model. Cancer Research, 70, 9808–9815.
Vicini, F. A., Eberlein, T. J., Connolly, J. L., Recht, A., Abner A., Schnitt, S. J., et al. (1991). The optimal extent of resection for patients with stages I or II breast cancer treated with conservative surgery and radiotherapy. Annals of Surgery, 214, 200-204.
Jacobs, L. (2008). Positive margins: the challenge continues for breast surgeons. Annals of Surgical Oncology, 15, 1271–1272.
Schwartz, G. F., Veronesi, U., Clough, K. B., Dixon, J. M., Fentiman, I. S., Heywang-Köbrunner S. H., et al. (2006). Consensus conference on breast conservation. Journal of the American College of Surgeons, 203, 198–207.
Pleijhuis, R. G., Graafland, M., Vries, J. D., Bart, J., Jong, J. S. D., & van Dam, G. M. (2009). Obtaining Adequate Surgical Margins in Breast-Conserving Therapy for Patients with Early-Stage Breast Cancer: Current Modalities and Future Directions. Annals of Surgical Oncology, 16, 2717–2730.
Tabar, L., Vitak, B., Chen, T. H.-H., Yen, A. M-F., Cohen, A., Tot, T., et al. (2011). Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology, 260(3), 658–663.
Screening IUPoBC. (2012). The benefits and harms of breast cancer screening: an independent review. Lancet, 380(9855), 1778–1786.
Meeting, F. (1996). Breast‐cancer screening with mammography in women aged 40–49 years. International Journal of Cancer, 68(6), 693–699.
Duffy, S., Tabar, L., Olsen, A., Vitak, B., Allgood, P., Chen, T. H.-H., et al. (2010). Cancer mortality in the 50–69 year age group before and after screening. Journal of Medical Screening, 17(3), 159–160.
Jensena, A., Ewertz, M., Cold, S., Storm, H., & Overgaard, J. (2003). Time trends and regional differences in registration, stage distribution, surgical management and survival of breast cancer in Denmark. European Journal of Cancer, 39 (12), 1783–1793.
Chen, T. H.-H., Jonsson, S. H, & Lenner, P. (2007). Effect of mammographic service screening on stage at presentation of breast cancers in Sweden. Cancer, 109(11), 2205–2212.
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