The Proportion of Women Who Have a Breast 4 Years after Breast Cancer Surgery: A Population-Based Cohort Study.

BACKGROUND: There are numerous pathways in breast cancer treatment, many of which enable women to retain a breast after treatment. We evaluated the proportion of women who have a breast, either through conserving surgery (BCS) or reconstruction, at 4-years after diagnosis, and how this varied by patient group. METHODS AND FINDINGS: We identified women with breast cancer who underwent initial BCS or mastectomy in English National Health Service (NHS) hospitals between January 2008 and December 2009 using the Hospital Episode Statistics (HES) database. Women were assigned into one of four patient groups depending on their age at diagnosis and presence of comorbidities. The series of breast cancer procedure (BCS, mastectomy, immediate, or delayed reconstruction) undergone by each women was identified over four years, and the proportion of women with a breast calculated. Variation was examined across patient groups, and English Cancer Networks. Between 2008 and 2009, 60,959 women underwent BCS or mastectomy. The proportion with a breast at 4 years was 79.3%, and 64.0%, in women less than 70 years without, and with comorbidities. Whilst in women aged 70 and over without, and with comorbidities, proportions were 52.6%, and 38.2%, respectively. Comorbidities were associated with lower proportions of BCS, but had little effect on reconstruction rates unlike age. Networks variation of 15% or more was found within each patient group, and Cancer Networks tended to have either a high or low proportion across all four patient groups. However, while 14% of women under 70 years had undergone reconstruction, less than 2% of women aged 70 or more had this treatment option. CONCLUSION: The proportion of women diagnosed with breast cancer who retain a breast at 4 years is strongly associated with age, and presence of comorbidities. There was significant variation between Cancer Networks indicating that women's experience in England was dependent on their geographical location of treatment

Bioengineeringof nerve conduits

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The bioengineering of nerve conduits

Poly-3-hydroxybutyrate (PHB) conduits are an alternative to nerve autografting and support regeneration across long nerve gaps, although to suboptimal levels. The aim of this study was to improve these results by combining PHB with glial growth factor (GGF), enhancing nerve regeneration by contact guidance and an improved trophic microenvironment. Two and 4cm gaps in the rabbit common peroneal nerve were bridged using PHB-GGF conduits. The rate and quantity of axonal and Schwann cell (SC) regeneration were assessed by quantitative immunohistochemistry at 21, 42 and 63 days, and compared to empty and alginate filled conduits. Addition of GGF improved axonal and SC regeneration, which was sustained up to 63 days independent of gap length. The distance and quantity of axonal regeneration were increased by up to 53% and 4317% respectively. At 120 days axonal and SC regeneration within the PHB-GGF grafts remained superior to the controls resulting in enhanced motor organ reinnervation, as was demonstrated by an improved recovery of muscle mass compared to the controls. In both the short and long term studies the alginate filled conduits resulted in regeneration inferior to both the GGF and empty tubes. As a result alginate fibres were assessed in vitro and in vivo as an alternative to alginate hydrogel with a potential to deliver GGF. However, regeneration in vivo in alginate fibre filled conduits was inferior to conduits filled with alginate hydrogel. Polyhydroxyalkatone (PHA) was also evaluated as a conduit material, as GGF linkage and release from its walls is a feasible option. Four different PHA configurations were used to bridge a 1cm rat sciatic nerve gap. All 4 PHA configurations, accelerated axonal regeneration rate to 1mm/day versus 0.7mm/day with PHB conduits and resulted in a quantity of axonal regeneration superior to that seen in the autograft repairs. In conclusion, GGF improves axonal and SC regeneration across short and long gaps through PHB conduits, but alginate hydrogel appears to limit the trophic effect of GGF. Alginate fibres provide no improvement, however alginate's limitations may be overcome and regeneration further improved by using PHA as a bioconstruct releasing GGF into the conduit microenvironment

Donor-Site Hernia Repair in Abdominal Flap Breast Reconstruction: A Population-Based Cohort Study of 7929 Patients.

BACKGROUND: The authors investigated hernia repair rates following pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, and deep inferior epigastric perforator (DIEP) flap breast reconstruction in English National Health Service hospitals. METHODS: Women diagnosed with breast cancer who underwent pedicled TRAM, free TRAM, or DIEP flap breast reconstruction procedures in English National Health Service hospitals between April of 2006 and March of 2012 were identified using the Hospital Episode Statistics database. Women who underwent mastectomy without reconstruction acted as controls, and hernia repair rates were calculated for all four groups. Multiple Cox regression was performed to estimate the relative risk of hernia repair among the reconstruction groups, adjusted for age, obesity, previous abdominal surgery, reconstruction year, and bilateral flap harvest. RESULTS: Between 2006 and 2012, 7929 women had a DIEP or TRAM flap breast reconstruction. The overall hernia repair rate within 3 years was 2.45 percent after abdominal flap breast reconstruction, and 0.28 percent among the 15,679 women who had mastectomy only. Mean time to hernia repair following an abdominal flap harvest was 17.7 months. Compared with DIEP flaps, free and pedicled TRAM flap procedures were associated with adjusted hazard ratios of 1.81 (95 percent CI, 1.24 to 2.64) and 2.89 (95 percent CI, 1.91 to 4.37), respectively. The only independent risk factor for hernia repair was age older than 60 years (p = 0.039). CONCLUSIONS: Abdominally based autologous breast reconstruction carries a small risk of subsequent donor-site hernia repair. The rates herein can be used to inform patients and to assess quality of care across service providers. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III

Variation across Cancer Networks of the proportion of women with a breast 4 years after initial cancer surgery through BCS and Reconstruction in patient group 1.

<p>Variation across Cancer Networks of the proportion of women with a breast 4 years after initial cancer surgery through BCS and Reconstruction in patient group 1.</p