Opportunities and priorities for breast surgical research

Cutress, Ramsey I.; McIntosh, Stuart A.; Potter, Shelley; Goyal, Amit; Kirwan, Cliona C.; Harvey, James; Francis, Adele; Carmichael, Amtul R.; Vidya, Raghavan; Vaidya, Jayant S.; Benson, John R.; Fairbrother, Patricia; Reed, Malcolm WR

Abstract

© 2018 Elsevier Ltd The 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery). Section leads were identified based on research interests, with invited input from experts in specific areas, supported by consultation with members of the Association of Breast Surgery and Independent Cancer Patients' Voice groups. The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Key research gaps included issues surrounding overdiagnosis and treatment; optimising treatment options and their selection for neoadjuvant therapies and subsequent surgery; reducing rates of re-operations for breast-conserving surgery; generating evidence for clinical effectiveness and cost-effectiveness of breast reconstruction, and mechanisms for assessing novel interventions; establishing optimal axillary management, especially post-neoadjuvant treatment; and defining and standardising indications for risk-reducing surgery. We propose strategies for resolving these knowledge gaps. Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and health-care systems. Development of infrastructure and surgical research capacity, together with appropriate allocation of research funding, is needed to successfully address the key clinical and translational research gaps that are highlighted in this Review within the next two decades.

• Journal Article Type: Review
• Acceptance Date: Jul 10, 2018
• Publication Date: Oct 1, 2018
• Deposit Date: Jul 31, 2018
• Publicly Available Date: Apr 1, 2019
• Journal: Lancet Oncology
• Print ISSN: 1470-2045
• Electronic ISSN: 1474-5488
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 10
• Pages: e521-e533
• DOI: https://doi.org/10.1016/S1470-2045%2818%2930511-4
• Keywords: visible difference, body image
• Public URL: https://uwe-repository.worktribe.com/output/859275
• Publisher URL: https://doi.org/10.1016/S1470-2045(18)30511-4
• Additional Information: Additional Information : This is the author's accepted manuscript. The final published version is available here: https://doi.org/10.1016/S1470-2045(18)30511-4; Corporate Creators : The Association of Breast Surgery Surgical Gap Analysis Working Group
• Contract Date: Jul 31, 2018