Clinical and patient-reported outcomes in women offered oncoplastic breast conserving surgery as an alternative to mastectomy in the ANTHEM multicentre, prospective cohort study

Davies, Charlotte; Johnson, Leigh; Conefrey, Carmel; Mills, Nicola; Fairbrother, Patricia; Holcombe, Chris; Whisker, Lisa; Hollingworth, William; Skillman, Joanna; White, Paul; MacMillan, Douglas; Comins, Charles; Potter, Shelley

Abstract

ABSTRACT

Background: Oncoplastic breast conserving surgery (OPBCS) may be a better option than mastectomy, but high-quality comparative evidence is lacking. The ANTHEM study (ISRCTN18238549) aimed to explore clinical and patient-reported outcomes in a multicentre cohort of women offered OPBCS as an alternative to mastectomy +/- immediate breast reconstruction (IBR).

Methods: Women aged >18 with invasive breast cancer or DCIS who were offered OPBCS to avoid mastectomy were recruited prospectively. Demographic, operative, oncological and 3- and 12-month complication data were collected. The proportion of women choosing OPBCS and the proportion in whom breast conservation was successful were calculated.
Participants completed the validated BREAST-Q at baseline, 3- and 12-months post-operatively. Questionnaires were scored according to the developers’ instructions and scores compared across timepoints in each group.

Results: 362 women from 32 breast units participated of whom 294 (81.2%) chose OPBCS. Of the OPBCS patients in whom post-operative margin status was reported, 210/255 (82.4%) had clear margins at initial surgery and only 10 (3.9%) required completion mastectomy. Major complications were significantly more likely after IBR.
Women having a successful therapeutic mammaplasty reported significant improvements in ‘Satisfaction with Breasts’ and ‘Psychosocial Well-being’ scores from baseline to 3- and 12-but both OPBCS group reported significant decreases in baseline ‘Physical Well-being’ at 3 and 12-months.

Conclusions: OPBCS allowed over 95% of women to avoid mastectomy with lower complication rates than IBR and improved patient-reported outcomes, especially after therapeutic mammaplasty. OPBCS should be offered as an alternative to mastectomy in all women in whom it is technically feasible.

• Journal Article Type: Article
• Acceptance Date: Nov 26, 2024
• Online Publication Date: Dec 24, 2024
• Publication Date: Jan 31, 2025
• Deposit Date: Nov 27, 2024
• Publicly Available Date: Feb 6, 2025
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 112
• Issue: 1
• Article Number: znae306
• Public URL: https://uwe-repository.worktribe.com/output/13468955