Dr Mona Tan’s Breast Surgery Outcomes

For those of you who are considering surgery at MammoCare, you may wish to know about Dr Tan’s personal results/audit of the outcomes of the patients that she treats. Her results here are listed against international publications.

Author Centre n Characteristics %BCT
Tan Mona MammoCare, Singapore 121
45
166
Symptomatic
Screen detected
Stage 0-IV
81.8%
95.5%
85.5%
Author Centre n Comments %BCT
Agarwal SEER, USA University of Michigan (1998-2008) 132 149 All patients.
Patients who underwent BCT had higher breast cancer specific survival than those who had mastectomy.
70%
van Hezewijk University Medical Centre, The Netherlands (various medical centres in the world) (2001-2006) 9779 TEAM (Tamoxifen and Exemestane Multinational) trial. Analysis showed a higher local recurrence risk after mastectomy only when compared with BCT + RT. 60%
Feigelson Institute for Health Research Kaiser Permanente (2003-2008) 2384 All tumours. Surgeons with very high volume of breast cancer operations (>50 annually) were less likely to perform mastectomies. 83.3%

Legend:

n – total number of patients in the study cohort
BCT – Breast Conservation Treatment
RT – Radiotherapy

References
1. Tan MP, Sim AS. An evaluation of eligibility and utilisation of breast conservation treatment in an Asian community. Breast 2013;22(Suppl 1):S80-81
2. Agarwal S, Pappas L, Neumayer L, et al. Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer. JAMA Surg 2014doi:10.1001/jamasurg2013.3049.
3. van Hezewijk M, Bastiaannet E, Putter H et al. Effect of local therapy on locoregional recurrence in postmenopausal women iwht breat cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) Trial. Radiotherapy and Oncology 2013;108:190-196.
4. Fiegelson HS, James TA, Single RM et al. Factors associated with the frequency of initial total mastectomy: Results of a multi-institutional study. J Am Coll Surg 2013;216:966-975.


 

Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer


Published on: January 15, 2014
Author: Agarwal et al
Centre: Department of Surgery, University of Michigan


If you are considering surgery with MammoCare, you may wish to take note of Dr Mona Tan’s expertise as published in medical journals.

Author Centre SLN Identification SLN false negative Comments
Lyman G, et al American Society of Clinical Oncology Greater than 85% Less than 5% Guideline rates should be met before abandoning axillary dissection as standard of care.
Tan Mona MammoCare, Singapore 96.2% 0 Meets all guideline requirements listed in reference (1).

References
1. Lyman G, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. J Clin Oncol 2005;23(30):7703-7720.
2. Tan MP. Surmounting the challenges of sentinel lymph node biopsy for breast cancer in non-tertiary centres and community-based practices. ANZ J. Surg 2006;76:306-309.


In order to minimise the need for a repeat operation for breast cancer, we at MammoCare advise a process of tissue examination known as ‘frozen section analysis’. This is not a perfect technique, but it does reduce the need for a second operation. As there is no data from any surgical centre in Singapore, we list our rates together with those reported at other international centres.

Author/Centre Findings on re-excision rate (BCT) using IFSA for margins Other relevant findings/comments
Esbona,University of Wisconsin Re-excision rates decreased from 27% to 6% Systematic review
Jorns,University of Michigan Re-excision rates decreased from 48.6% to 14.9% Reoperation rates decreased from 55.3% to 19.3%
Fukamachi Tohoku University Reduction of margin positive rates from 27% to 9.8%
MammoCare(2009-2011) 0% No re-excision rates for margins with IFSA Reoperation rates for axillary node positivity 0.8%

1. Esbona K, Li ZH, Wilke LG. Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systemic review. Ann Surg Oncol 2012;doi 10.1245/s10434-012-2492-2

2. Jorns JM, Visscher D, Sabel M, et al.Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates. Am J ClinPathol 2012;138:657-669.

3. Fukamachi K, Ishida T, Usami S, et al. Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Jpn J Clin Oncol 2010;40:513-520.

Once again, in order to streamline the care for our patients, we, together with our colleagues arrange for our patients to reduce the need for reoperation.


Our Locations

Mount Elizabeth Novena Hospital
38 Irrawaddy Road, #06-21
Mount Elizabeth Novena Hospital
Singapore 329563
Phone: (65) 6694 1706

Mount Elizabeth Orchard
3 Mt Elizabeth, #11-02,
Mount Elizabeth Medical Centre
Singapore 228510
Phone: (65) 6734 4880

Consultation Hours

Mon - Fri: 9 am to 12:30pm; 2 pm to 5 pm
Sat: Strictly by Appointment