82 results on '"Ashu Gandhi"'
Search Results
2. No association between breast pain and breast cancer
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Rajiv V. Dave, Hannah Bromley, Vicky P. Taxiarchi, Elizabeth Camacho, Sumohan Chatterjee, Nicola Barnes, Gillian Hutchison, Paul Bishop, Cliona C. Kirwan, and Ashu Gandhi
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2023
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3. Uptake of bilateral-risk-reducing-mastectomy: Prospective analysis of 7195 women at high-risk of breast cancer
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D.Gareth Evans, Ashu Gandhi, Julie Wisely, Tara Clancy, Emma R. Woodward, James Harvey, Lyndsey Highton, John Murphy, Lester Barr, Sacha J. Howell, Fiona Lalloo, Elaine F. Harkness, and Anthony Howell
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Risk reducing mastectomy ,Predictors ,Prevention ,Breast cancer ,BRCA1 ,BRCA2 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Bilateral-Risk-Reducing-Mastectomy-(BRRM) is well described in BRCA1/2 pathogenic variant carriers. However, little is known about the relative uptake, time trends or factors influencing uptake in those at increased breast cancer risk not known to be carriers. The aim of this study is to assess these factors in both groups. Methods: BRRM uptake was assessed from entry to the Manchester Family History Clinic or from date of personal BRCA1/2 test. Follow up was censored at BRRM, breast cancer diagnosis, death or January 01, 2020. Cumulative incidence and cause specific and competing risk regression analyses were used to assess the significance of factors associated with BRRM. Results: Of 7195 women at ≥25% lifetime breast cancer risk followed for up to 32 years, 451 (6.2%) underwent pre-symptomatic BRRM. Of those eligible in different risk groups the 20-year uptake of BRRM was 47.7%-(95%CI = 42.4–53.2%) in 479 BRCA1/2 carriers; 9.0% (95%CI = 7.26–11.24%) in 1261 women at ≥40% lifetime risk (non-BRCA), 4.8%-(95%CI = 3.98–5.73%) in 3561 women at 30–39% risk and 2.9%-(95%CI = 2.09–4.09%) in 1783 women at 25–29% lifetime risk. In cause-specific Cox regression analysis death of a sister with breast cancer50; OR = 0.26,95%CI = 0.17–0.41). Uptake continued to rise to 20 years from initial risk assessment. Conclusion: We have identified several additional factors that correlate with BRRM uptake and demonstrate continued increases over time. These factors will help to tailor counselling and support for women.
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- 2021
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4. The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer
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Narendra Nath Basu, James Hodson, Shaunak Chatterjee, Ashu Gandhi, Julie Wisely, James Harvey, Lyndsey Highton, John Murphy, Nicola Barnes, Richard Johnson, Lester Barr, Cliona C. Kirwan, Sacha Howell, Andrew D. Baildam, Anthony Howell, and D. Gareth Evans
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Medicine ,Science - Abstract
Abstract Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987–2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie’s announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11–54) days after the index cancer surgery. Rates of CRRM doubled following AJ’s news, from 23.9% pre-AJ to 50.0% post AJ (p
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- 2021
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5. Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)
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Anthony Howell, Ashu Gandhi, Sacha Howell, Mary Wilson, Anthony Maxwell, Susan Astley, Michelle Harvie, Mary Pegington, Lester Barr, Andrew Baildam, Elaine Harkness, Penelope Hopwood, Julie Wisely, Andrea Wilding, Rosemary Greenhalgh, Jenny Affen, Andrew Maurice, Sally Cole, Julia Wiseman, Fiona Lalloo, David P. French, and D. Gareth Evans
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family history ,breast cancer ,risk ,genes ,screening ,prevention ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
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- 2020
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6. Anti-estrogen Resistance in Human Breast Tumors Is Driven by JAG1-NOTCH4-Dependent Cancer Stem Cell Activity
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Bruno M. Simões, Ciara S. O’Brien, Rachel Eyre, Andreia Silva, Ling Yu, Aida Sarmiento-Castro, Denis G. Alférez, Kath Spence, Angélica Santiago-Gómez, Francesca Chemi, Ahmet Acar, Ashu Gandhi, Anthony Howell, Keith Brennan, Lisa Rydén, Stefania Catalano, Sebastiano Andó, Julia Gee, Ahmet Ucar, Andrew H. Sims, Elisabetta Marangoni, Gillian Farnie, Göran Landberg, Sacha J. Howell, and Robert B. Clarke
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Biology (General) ,QH301-705.5 - Abstract
Breast cancers (BCs) typically express estrogen receptors (ERs) but frequently exhibit de novo or acquired resistance to hormonal therapies. Here, we show that short-term treatment with the anti-estrogens tamoxifen or fulvestrant decrease cell proliferation but increase BC stem cell (BCSC) activity through JAG1-NOTCH4 receptor activation both in patient-derived samples and xenograft (PDX) tumors. In support of this mechanism, we demonstrate that high ALDH1 predicts resistance in women treated with tamoxifen and that a NOTCH4/HES/HEY gene signature predicts for a poor response/prognosis in 2 ER+ patient cohorts. Targeting of NOTCH4 reverses the increase in Notch and BCSC activity induced by anti-estrogens. Importantly, in PDX tumors with acquired tamoxifen resistance, NOTCH4 inhibition reduced BCSC activity. Thus, we establish that BCSC and NOTCH4 activities predict both de novo and acquired tamoxifen resistance and that combining endocrine therapy with targeting JAG1-NOTCH4 overcomes resistance in human breast cancers.
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- 2015
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7. Detection of pathogenic variants in breast cancer susceptibility genes in bilateral breast cancer
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D Gareth Evans, George J Burghel, Helene Schlecht, Elaine F Harkness, Ashu Gandhi, Sacha J Howell, Anthony Howell, Claire Forde, Fiona Lalloo, William G Newman, Miriam Jane Smith, and Emma Roisin Woodward
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Genetics ,Genetics (clinical) - Abstract
PurposeTo investigate the frequency of germline pathogenic variants (PVs) in women with bilateral breast cancer.MethodsWe undertookBRCA1/2andCHEK2c.1100delC molecular analysis in 764 samples and a multigene panel in 156. Detection rates were assessed by age at first primary, Manchester Score, and breast pathology. Oestrogen receptor (ER) status of the contralateral versus first breast cancer was compared on 1081 patients with breast cancer withBRCA1/BRCA2PVs.Results764 women with bilateral breast cancer have undergone testing ofBRCA1/2andCHEK2; 407 were also tested forPALB2and 177 forATM. Detection rates wereBRCA111.6%,BRCA214.0%,CHEK22.4%,PALB21.0%,ATM1.1% and, for a subset of mainly very early onset tumours,TP534.6% (9 of 195). The highest PV detection rates were for triple negative cancers forBRCA1(26.4%), grade 3 ER+HER2 forBRCA2(27.9%) and HER2+ forCHEK2(8.9%). ER status of the first primary inBRCA1andBRCA2PV heterozygotes was strongly predictive of the ER status of the second contralateral tumour since ~90% of second tumours were ER− inBRCA1heterozygotes, and 50% were ER− inBRCA2heterozygotes if the first was ER−.ConclusionWe have shown a high rate of detection ofBRCA1andBRCA2PVs in triple negative and grade 3 ER+HER2− first primary diagnoses, respectively. High rates of HER2+ were associated withCHEK2PVs, and women ≤30 years were associated withTP53PVs. First primary ER status inBRCA1/2strongly predicts the second tumour will be the same ER status even if unusual for PVs in that gene.
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- 2023
8. Breast Volume Measurement Using a Games Console Input Device.
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Stefanie T. L. Pöhlmann, Jeremy Hewes, Andrew I. Williamson, Jamie C. Sergeant, Alan Hufton, Ashu Gandhi, Christopher J. Taylor 0001, and Susan M. Astley
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- 2014
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9. No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic
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Rajiv V Dave, Hannah Bromley, Vicky P Taxiarchi, Elizabeth Camacho, Sumohan Chatterjee, Nicola Barnes, Gillian Hutchison, Paul Bishop, William Hamilton, Cliona C Kirwan, and Ashu Gandhi
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Cost-Benefit Analysis ,Humans ,Breast Neoplasms ,Female ,Prospective Studies ,Quality-Adjusted Life Years ,skin and connective tissue diseases ,Family Practice ,Mastodynia ,State Medicine - Abstract
BackgroundWomen with breast pain constitute >20% of breast clinic attendees.AimTo investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care.Design and settingA prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months.MethodWomen were categorised by presentation into four distinct clinical groups and cancer incidence investigated.ResultsOf 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with ∼5% in each of the three other clinical groups. Using ‘breast lump’ as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, PConclusionThis study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.
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- 2021
10. Uptake of bilateral-risk-reducing-mastectomy: Prospective analysis of 7195 women at high-risk of breast cancer
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Lyndsey Highton, D. Gareth Evans, Ashu Gandhi, James Harvey, Sacha J Howell, Fiona Lalloo, John Murphy, Emma R. Woodward, Anthony Howell, Tara Clancy, Lester Barr, Elaine F. Harkness, and Julie Wisely
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medicine.medical_specialty ,Heterozygote ,Risk reducing mastectomy ,BC, Breast cancer ,BRRM, Bilateral Risk Reducing Mastectomy ,Breast Neoplasms ,Risk Assessment ,Prospective analysis ,Breast cancer ,medicine ,Humans ,Cumulative incidence ,Family history ,Child ,Mastectomy ,RC254-282 ,Obstetrics ,Proportional hazards model ,business.industry ,Predictors ,Breast Neoplasms/epidemiology ,Incidence ,Prevention ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,General Medicine ,medicine.disease ,BRCA1 ,PV, Pathogenic variant ,BRCA2 ,Mutation ,Surgery ,Lifetime risk ,Original Article ,Female ,business ,Risk assessment - Abstract
Background Bilateral-Risk-Reducing-Mastectomy-(BRRM) is well described in BRCA1/2 pathogenic variant carriers. However, little is known about the relative uptake, time trends or factors influencing uptake in those at increased breast cancer risk not known to be carriers. The aim of this study is to assess these factors in both groups. Methods BRRM uptake was assessed from entry to the Manchester Family History Clinic or from date of personal BRCA1/2 test. Follow up was censored at BRRM, breast cancer diagnosis, death or January 01, 2020. Cumulative incidence and cause specific and competing risk regression analyses were used to assess the significance of factors associated with BRRM. Results Of 7195 women at ≥25% lifetime breast cancer risk followed for up to 32 years, 451 (6.2%) underwent pre-symptomatic BRRM. Of those eligible in different risk groups the 20-year uptake of BRRM was 47.7%-(95%CI = 42.4–53.2%) in 479 BRCA1/2 carriers; 9.0% (95%CI = 7.26–11.24%) in 1261 women at ≥40% lifetime risk (non-BRCA), 4.8%-(95%CI = 3.98–5.73%) in 3561 women at 30–39% risk and 2.9%-(95%CI = 2.09–4.09%) in 1783 women at 25–29% lifetime risk. In cause-specific Cox regression analysis death of a sister with breast cancer50; OR = 0.26,95%CI = 0.17–0.41). Uptake continued to rise to 20 years from initial risk assessment. Conclusion We have identified several additional factors that correlate with BRRM uptake and demonstrate continued increases over time. These factors will help to tailor counselling and support for women., Highlights • BRRM continues even 20 years post original breast cancer risk assessment. • Potential triggers include death of mother/sister, children and a breast biopsy. • Uptake is clearly informed by lifetime risk of BC and higher in younger the women.
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- 2021
11. Probity and Professional Standards
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Ashu Gandhi
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- 2022
12. Differential involvement of germline pathogenic variants in breast cancer genes between DCIS and low-grade invasive cancers
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D Gareth Evans, Siva Sithambaram, Elke Maria van Veen, George J Burghel, Helene Schlecht, Elaine F Harkness, Helen Byers, Jamie M Ellingford, Ashu Gandhi, Sacha J Howell, Anthony Howell, Claire Forde, Fiona Lalloo, William G Newman, Miriam Jane Smith, and Emma Roisin Woodward
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Manchester Cancer Research Centre ,ResearchInstitutes_Networks_Beacons/mcrc ,Genetics ,Genetics (clinical) - Abstract
PurposeTo investigate frequency of germline pathogenic variants (PVs) in women with ductal carcinoma in situ (DCIS) and grade 1 invasive breast cancer (G1BC).MethodsWe undertookBRCA1/2analysis in 311 women with DCIS and 392 with G1BC and extended panel testing (non-BRCA1/2) in 176/311 with DCIS and 156/392 with G1BC. We investigated PV detection by age at diagnosis, Manchester Score (MS), DCIS grade and receptor status.Results30/311 (9.6%) with DCIS and 16/392 with G1BC (4.1%) had aBRCA1/2PV (p=0.003), and 24/176-(13.6%) and 7/156-(4.5%), respectively, a non-BRCA1/2PV (p=0.004). Increasing MS was associated with increased likelihood ofBRCA1/2PV in both DCIS and G1BC, although the 10% threshold was not predictive for G1GB. 13/32 (40.6%) DCIS and 0/17 with G1BC BRCA1/2) and 9/90 (non-BRCA1/2), and 8/47 (BRCA1/2) and 8/45 (non-BRCA1/2), respectively. 6/9BRCA1and 3/26BRCA2-associated DCIS were oestrogen receptor negative-(p=0.003). G1BC population testing showed no increased PV rate (OR=1.16, 95% CI 0.28 to 4.80).ConclusionDCIS is more likely to be associated with bothBRCA1/2and non-BRCA1/2PVs than G1BC. Extended panel testing ought to be offered in young-onset DCIS where PV detection rates are highest.
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- 2022
13. Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer?
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Ashu Gandhi and J Murphy
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Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Breast Neoplasms ,Mastectomy, Segmental ,medicine.disease ,Breast cancer ,Internal medicine ,medicine ,Overall survival ,Humans ,Female ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,business ,Mastectomy ,Neoplasm Staging ,Retrospective Studies ,SEER Program - Published
- 2021
14. A digital pathway for genetic testing in UK NHS patients with cancer:BRCA-DIRECT randomised study internal pilot
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Bethany Torr, Christopher Jones, Subin Choi, Sophie Allen, Grace Kavanaugh, Monica Hamill, Alice Garrett, Suzanne MacMahon, Lucy Loong, Alistair Reay, Lina Yuan, Mikel Valganon Petrizan, Kathryn Monson, Nicky Perry, Lesley Fallowfield, Valerie Jenkins, Rochelle Gold, Amy Taylor, Rhian Gabe, Jennifer Wiggins, Anneke Lucassen, Ranjit Manchanda, Ashu Gandhi, Angela George, Michael Hubank, Zoe Kemp, D Gareth Evans, Stephen Bremner, and Clare Turnbull
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Manchester Cancer Research Centre ,ResearchInstitutes_Networks_Beacons/mcrc ,Genetics ,Humans ,Female ,Breast Neoplasms ,Genetic Testing ,Referral and Consultation ,State Medicine ,United Kingdom ,Genetics (clinical) ,Telephone - Abstract
BackgroundGermline genetic testing affords multiple opportunities for women with breast cancer, however, current UK NHS models for delivery of germline genetic testing are clinician-intensive and only a minority of breast cancer cases access testing.MethodsWe designed a rapid, digital pathway, supported by a genetics specialist hotline, for delivery of germline testing ofBRCA1/BRCA2/PALB2(BRCA-testing), integrated into routine UK NHS breast cancer care. We piloted the pathway, as part of the larger BRCA-DIRECT study, in 130 unselected patients with breast cancer and gathered preliminary data from a randomised comparison of delivery of pretest information digitally (fully digital pathway) or via telephone consultation with a genetics professional (partially digital pathway).ResultsUptake of genetic testing was 98.4%, with good satisfaction reported for both the fully and partially digital pathways. Similar outcomes were observed in both arms regarding patient knowledge score and anxiety, with ConclusionPilot data indicate preliminary demonstration of feasibility and acceptability of a fully digital pathway for BRCA-testing and support proceeding to a full powered study for evaluation of non-inferiority of the fully digital pathway, detailed quantitative assessment of outcomes and operational economic analyses.Trial registration numberISRCTN87845055.
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- 2022
15. Surgical Outcome Measures in a Cohort of Patients at High Risk of Breast Cancer Treated by Bilateral Risk-Reducing Mastectomy and Breast Reconstruction
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Ashu Gandhi, Paula Duxbury, Tara Clancy, Fiona Lalloo, Julie A. Wisely, Cliona C. Kirwan, Philip Foden, Katie Stocking, Anthony Howell, and D. Gareth Evans
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Postoperative Complications ,Treatment Outcome ,Mammaplasty ,Outcome Assessment, Health Care ,Humans ,Surgery ,Breast Neoplasms ,Female ,Mastectomy - Abstract
Women with breast cancer-related genetic pathogenic variants (e.g., BRCA1 , BRCA2 ) or with a strong family history carry lifetime risks of developing breast cancer of up to 80 to 90 percent. A significant proportion of these women proceed to bilateral risk-reducing mastectomy. The authors aimed to document the surgical morbidity of risk-reducing mastectomy and establish whether a diagnosis of breast cancer at the time of surgery impacted outcomes.Clinical details of 445 women identified as having a greater than 25 percent lifetime risk of developing breast cancer who underwent risk-reducing mastectomy and breast reconstruction were interrogated for surgical outcomes such as planned, unplanned, and emergency procedures; complication rates; length of stay; and longevity of breast reconstruction. These outcome measures were recorded in women diagnosed with breast cancer perioperatively (cancer group) and those without malignancy (benign group).Median follow-up was similar in both groups (benign group, 70 months; cancer group, 73 months). Patients were older in the cancer group than in the benign group (43 years versus 39 years; p0.001). Women in the cancer group required more planned procedures to complete reconstruction than those in the benign group (four versus two; p = 0.002). Emergency procedures, unplanned surgical interventions (e.g., capsulectomy), and postreconstruction complication rates were similar between groups. One in five women overall required revision surgery. Patients with autologous reconstructions had a revision rate of 1.24 per 1000 person-years compared with 2.52 per 1000 person-years in the implant reconstruction group.Women contemplating risk-reducing mastectomy can be reassured that this is a safe and effective procedure but will likely take multiple interventions. This knowledge should be integral to obtaining informed consent.Risk, II.
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- 2022
16. Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
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Jamie J Kirkham, Ellen Copson, Baek Kim, Shelley Potter, Charlotte E. Coles, Nisha Sharma, Elizabeth Camacho, Kieran Horgan, Stuart McIntosh, Daniel R. Leff, Rachel O'Connell, Rajiv V. Dave, Chris Holcombe, Ramsey I. Cutress, Patricia Fairbrother, Christopher W. J. Cartlidge, Ashu Gandhi, Vicky P. Taxiarchi, Alona Courtney, Tim Rattay, Raghavan Vidya, Cliona C. Kirwan, Dave, Rajiv V. [0000-0001-6827-8090], McIntosh, Stuart A. [0000-0002-4123-9611], Potter, Shelley [0000-0002-6977-312X], Copson, Ellen [0000-0001-8994-4056], Apollo - University of Cambridge Repository, Cancer Research UK, Dave, Rajiv V [0000-0001-6827-8090], and McIntosh, Stuart A [0000-0002-4123-9611]
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Cancer Research ,692/700/784 ,medicine.medical_treatment ,Cohort Studies ,0302 clinical medicine ,Breast cancer ,Quality of life ,Surgical oncology ,Pandemic ,Epidemiology ,030212 general & internal medicine ,692/700/1538 ,Aged, 80 and over ,Covid19 ,health policy ,Middle Aged ,Health care economics ,Health policy ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Female ,Breast reconstruction ,Life Sciences & Biomedicine ,B-MaP-C study collaborative ,Cohort study ,Adult ,medicine.medical_specialty ,Breast Neoplasms ,Article ,1117 Public Health and Health Services ,692/4028/546 ,surgical oncology ,03 medical and health sciences ,breast cancer ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,1112 Oncology and Carcinogenesis ,692/700/3934 ,Oncology & Carcinogenesis ,Aged ,Science & Technology ,business.industry ,SARS-CoV-2 ,COVID-19 ,health care economics ,medicine.disease ,Radiation therapy ,quality of life ,Emergency medicine ,692/4028/67/1347 ,business - Abstract
Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
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- 2021
17. Uptake and efficacy of bilateral risk reducing surgery in unaffected female BRCA1 and BRCA2 carriers
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Julie Wissely, Elaine F. Harkness, D. Gareth Evans, Richard J. Edmondson, Anthony Howell, Ruta Marcinkute, Ashu Gandhi, John D. Murphy, Cathrine Holland, Emma R. Woodward, Lester Barr, Richard D Clayton, James Harvey, Emma J Crosbie, Lindsay Highton, Fiona Lalloo, and Sacha J Howell
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Adult ,Oncology ,Heterozygote ,medicine.medical_specialty ,Adolescent ,Risk reducing mastectomy ,Genes, BRCA2 ,Genes, BRCA1 ,Salpingo-oophorectomy ,Breast Neoplasms/genetics ,Risk Assessment ,Ovarian Neoplasms/genetics ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,Genetics ,medicine ,Humans ,Prospective Studies ,Genetics (clinical) ,Aged ,Aged, 80 and over ,Risk reducing surgery ,030219 obstetrics & reproductive medicine ,Manchester Cancer Research Centre ,business.industry ,Proportional hazards model ,ResearchInstitutes_Networks_Beacons/mcrc ,Incidence (epidemiology) ,Prophylactic Surgical Procedures ,Middle Aged ,medicine.disease ,Prophylactic Mastectomy ,Cancer incidence ,030220 oncology & carcinogenesis ,Population study ,Female ,business ,Ovarian cancer ,Follow-Up Studies - Abstract
BackgroundWomen testing positive for BRCA1/2 pathogenic variants have high lifetime risks of breast cancer (BC) and ovarian cancer. The effectiveness of risk reducing surgery (RRS) has been demonstrated in numerous previous studies. We evaluated long-term uptake, timing and effectiveness of risk reducing mastectomy (RRM) and bilateral salpingo-oophorectomy (RRSO) in healthy BRCA1/2 carriers.MethodsWomen were prospectively followed up from positive genetic test (GT) result to censor date. χ² testing compared categorical variables; Cox regression model estimated HRs and 95% CI for BC/ovarian cancer cases associated with RRS, and impact on all-cause mortality; Kaplan-Meier curves estimated cumulative RRS uptake. The annual cancer incidence was estimated by women-years at risk.ResultsIn total, 887 women were included in this analysis. Mean follow-up was 6.26 years (range=0.01–24.3; total=4685.4 women-years). RRS was performed in 512 women, 73 before GT. Overall RRM uptake was 57.9% and RRSO uptake was 78.6%. The median time from GT to RRM was 18.4 months, and from GT to RRSO–10.0 months. Annual BC incidence in the study population was 1.28%. Relative BC risk reduction (RRM versus non-RRM) was 94%. Risk reduction of ovarian cancer (RRSO versus non-RRSO) was 100%.ConclusionOver a 24-year period, we observed an increasing number of women opting for RRS. We showed that the timing of RRS remains suboptimal, especially in women undergoing RRSO. Both RRM and RRSO showed a significant effect on relevant cancer risk reduction. However, there was no statistically significant RRSO protective effect on BC.
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- 2021
18. Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester
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L Walter, Rajiv V. Dave, Ashu Gandhi, P Wright, H L Bromley, M Rowland, N Lord, and M Preston
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Adult ,Male ,medicine.medical_specialty ,Referral ,Breast surgery ,medicine.medical_treatment ,Clinical Decision-Making ,Primary health care ,Primary care ,Secondary care ,Breast Surgery ,medicine ,Humans ,Referral and Consultation ,Aged ,Primary Health Care ,business.industry ,Data Visualization ,Infographic ,General Medicine ,Middle Aged ,United Kingdom ,Male patient ,Family medicine ,Practice Guidelines as Topic ,Etiology ,Gynecomastia ,Surgery ,business - Abstract
Introduction Men with gynaecomastia are routinely referred to breast clinics, yet most do not require breast surgical intervention. The aim of this study was to assess the impact of a novel point-of-care gynaecomastia decision infographic in primary care on the assessment, management and referral practices to tertiary breast surgical services. Methods A study was carried out of male patient referrals from primary care in Greater Manchester to a tertiary breast centre between January and March in 2018–2020. Referral patterns were compared before and after the infographic went live in general practices in Greater Manchester in January 2020. Data were collected for gynaecomastia referrals, including aetiology, investigation and management. Results In total, 394 men were referred to a tertiary breast centre from 163 general practices, of which 271 (68.8%) had a diagnosis of gynaecomastia. Use of the decision infographic by primary healthcare providers was associated with a decrease in male breast referrals with gynaecomastia (79.6% to 62.0%). Fewer gynaecomastia patients were referred with a benign physiological or drug-related cause after implementation of the infographic (52.2% vs 41.8%). Only 10 (3.7%) patients with gynaecomastia underwent breast surgery during the study period. Conclusion Implementation of a gynaecomastia infographic in primary care in Manchester was associated with a reduction in gynaecomastia referrals to secondary care. We hypothesise that implementation of the infographic into primary care nationally may potentially translate to hundreds of patients receiving more specialty-appropriate referrals, improving overall management of gynaecomastia. Further study is warranted to test this hypothesis.
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- 2022
19. The B-MaP-C study: Breast cancer management pathways during the COVID-19 pandemic. Study protocol
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Ellen Copson, Ashu Gandhi, Rachel O'Connell, Rajiv V. Dave, Charlotte E. Coles, Shelley Potter, Stuart McIntosh, Kieran Horgan, Nisha Sharma, Daniel R. Leff, Patricia Fairbrother, Tim Rattay, Chris Holcombe, Ramsey I. Cutress, Cliona C. Kirwan, Alona Courtney, Christopher W. J. Cartlidge, Raghavan Vidya, Baek Kim, Coles, Charlotte [0000-0003-4473-8552], and Apollo - University of Cambridge Repository
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,SATISFACTION ,IMPACT ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Outcomes ,Audit ,030230 surgery ,GUIDELINES ,THERAPY ,Article ,ANASTROZOLE ,03 medical and health sciences ,PROSPECTIVE MULTICENTER COHORT ,Breast cancer ,0302 clinical medicine ,Standard treatment ,SDG 3 - Good Health and Well-being ,Pandemic ,Medicine ,030212 general & internal medicine ,TAMOXIFEN ,Protocol (science) ,OUTCOMES ,Science & Technology ,business.industry ,Corporate governance ,COVID-19 ,medicine.disease ,Treatment ,Family medicine ,IMMEDIATE ,Surgery ,business ,Life Sciences & Biomedicine - Abstract
Introduction: Approximately 55,000 women in the United Kingdom are diagnosed with new breast cancer annually. Since emerging in December 2019, SARS-CoV-2 (coronavirus disease 2019, COVID-19) has become a global pandemic, affecting healthcare delivery worldwide. In response to the pandemic, multiple guidelines were issued to assist with rationalising breast cancer care. The primary aim of the B-MaP-C study is to audit and describe breast cancer management of patients newly diagnosed with breast cancer during the COVID-19 pandemic against pre-COVID-19 management practice in the UK. The implications of changes to management will be determined and the impact of a COVID-19 diagnosis on the patient's breast cancer management will be determined. Methods and analysis: This is a multi-centre collaborative audit of consecutive breast cancer patients undergoing treatment decisions during the acute and recovery phases of the COVID-19 pandemic. All patients with newly diagnosed primary breast cancer, whose treatment was decided in a multidisciplinary meeting from the 16th March 2020, are eligible for inclusion. Ethics and dissemination: As this is an audit ethical approval is not required. Each participating centre is required to register the study locally and obtain local governance approvals prior to commencement of data collection. Local audit data will be available to individual participating units for governance purposes. The results of the data analysis will be submitted for publication, as well as disseminated via the ABS newsletter and a webinar. All data will be presented at national and international conferences, circumstances permitting. Registration details: Each participating centre received local governance audit registration.
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- 2020
20. Efficient management of new patient referrals: Further data with increased numbers confirms the safety of advanced nurse practitioner (ANP) led telephone breast pain clinics
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Claire Robinson, Katie Ellis, Hiba Fatayer, Nader Touqan, and Ashu Gandhi
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Oncology ,Surgery ,General Medicine - Published
- 2022
21. Oncoplastic breast surgery: A guide to good practice
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Raghavan Vidya, Ramsey I. Cutress, Emma Pennery, Adam Gilmour, Ashu Gandhi, Diana Harcourt, Lee Martin, J. Murphy, Rachel Tillett, J. Mansell, and K. Little
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medicine.medical_specialty ,Breast Implants ,Mammaplasty ,Breast surgery ,medicine.medical_treatment ,MEDLINE ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Patient Education as Topic ,Health care ,Humans ,Medicine ,Formerly Health & Social Sciences ,Stage (cooking) ,Good practice ,skin and connective tissue diseases ,Mastectomy ,business.industry ,Data Collection ,Patient Selection ,General surgery ,Centre for Appearance Research ,General Medicine ,medicine.disease ,United Kingdom ,Oncology ,030220 oncology & carcinogenesis ,Female ,Surgery ,Enhanced Recovery After Surgery ,Breast reconstruction ,business ,Decision Making, Shared ,Breast cancer, surgery, guidelines - Abstract
Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.
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- 2021
22. Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons
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Adam Gilmour, Ashu Gandhi, Lisa Whisker, James Harvey, Matthew Barber, Shelley Potter, Lee Martin, Rachel Tillett, and Donna Egbeare
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medicine.medical_specialty ,Esthetics ,Association (object-oriented programming) ,Breast surgery ,medicine.medical_treatment ,ADM ,Breast Implants ,Mammaplasty ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Clinical decision making ,Medicine ,breast reconstruction ,Humans ,business.industry ,General surgery ,General Medicine ,Guideline ,Surgical Mesh ,Optimal management ,Oncology ,mesh ,synthetic ,030220 oncology & carcinogenesis ,Surgery ,Female ,Breast reconstruction ,business ,Dermal matrix ,guideline ,biological - Abstract
These guidelines have been produced with the involvement of the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Recommendations have been derived after a review of published data regarding the use of acellular dermal matrix (ADM), biological and synthetic mesh in breast reconstruction. The guidelines represent a consensus opinion on the optimal management of patients having biological or synthetic mesh assisted breast reconstruction informed by peer-review publications. The Guidelines should be used to inform clinical decision making. Ultimately, members of the MDT remain responsible for the treatment of patients under their care.
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- 2021
23. MAMMA (Mastitis And Mammary Abscess Management Audit): Phase 2 outcomes
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Alona Courtney, Ruth Parks, Alexander Wilkins, Ruth Brown, Rachel O'Connell, Rajiv Dave, Marianne Dillon, Hiba Fatayer, Rachel Gallimore, Ashu Gandhi, Matthew Gardiner, Victoria Harmer, Lyndsey Hookway, Gareth Irwin, Charlotte Ives, Helen Mathers, Juliette Murray, Peter O’Leary, Neill Patani, Sophie Paterson, Shelley Potter, Ruth Prichard, Giovanni Satta, T.G. Teoh, Paul Ziprin, and Daniel R. Leff
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Oncology ,Surgery ,General Medicine - Published
- 2022
24. Breast cancer incidence and early diagnosis in a family history risk and prevention clinic: 33-year experience in 14,311 women
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Andrew J Wallace, Anthony J. Maxwell, Anthony Howell, James Harvey, Elaine F. Harkness, Fiona Lalloo, Sacha J Howell, Mary Wilson, Yit Yoong Lim, Emma R. Woodward, Elke M van Veen, Lester Barr, Ashu Gandhi, Emma Hurley, and D. Gareth Evans
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Adult ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Mammography ,Humans ,Mass Screening ,030212 general & internal medicine ,Stage (cooking) ,Family history ,Early Detection of Cancer ,Screen detected ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Incidence ,Breast Neoplasms/diagnosis ,Cancer ,medicine.disease ,BRCA1 ,Magnetic Resonance Imaging ,Clinical Trial ,BRCA2 ,Oncology ,030220 oncology & carcinogenesis ,Mutation ,Population data ,Screening ,Female ,business ,MRI - Abstract
Purpose Women at increased familial breast cancer risk have been offered screening starting at an earlier age and increased frequency than national Screening Programmes for over 30 years. There are limited data on longer-term largescale implementation of this approach on cancer diagnosis. Methods Women at our institution at ≥ 17% lifetime breast cancer risk have been offered enhanced screening with annual mammography starting at age 35 or 5-years younger than youngest affected relative, with upper age limit 50 for moderate and 60 for high-risk. Breast cancer pathology, stage and receptor status were assessed as well as survival from cancer diagnosis by Kaplan–Meier analysis. Results Overall 14,311 women were seen and assessed for breast cancer risk, with 649 breast cancers occurring in 129,119 years follow up (post-prevalent annual incidence = 4.55/1000). Of 323/394 invasive breast cancers occurring whilst on enhanced screening, most were lymph-node negative (72.9%), T1 (≤ 20 mm, 73.2%) and stage-1 (61.4%), 126/394 stage2–4 (32%). 10-year breast cancer specific survival was 91.3% (95% CI 87.4–94.0) better than the 75.9% (95% CI 74.9–77.0) published for England in 2013–2017. As expected, survival was significantly better for women with screen detected cancers (p n = 75; 95% CI 84.2–97.6). Women with lobular breast cancers had worse 10-year survival at 85.9% (95% CI 66.7–94.5). Breast cancer specific survival was good for 119 BRCA1/2 carriers with 20-year survival in BRCA1:91.2% (95% CI 77.8–96.6) and 83.8% (62.6–93.5) for BRCA2. Conclusions Targeted breast screening in women aged 30–60 years at increased familial risk is associated with good long-term survival that is substantially better than expected from population data.
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- 2021
25. The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer
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James Harvey, Shaunak Chatterjee, Julie Wisely, Andrew D. Baildam, Richard J Johnson, L Barr, John Murphy, Sacha Howell, Nicola Barnes, D. Gareth Evans, Anthony Howell, James Hodson, Lyndsey Highton, Cliona C. Kirwan, Narendra Nath Basu, and Ashu Gandhi
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Adult ,Counseling ,medicine.medical_specialty ,Science ,medicine.medical_treatment ,Article ,03 medical and health sciences ,Breast cancer ,0302 clinical medicine ,Interquartile range ,Unilateral Breast Neoplasms ,Humans ,Medicine ,Genetic Predisposition to Disease ,Mass Media ,Prospective Studies ,030212 general & internal medicine ,Stage (cooking) ,Family history ,Medical History Taking ,Prospective cohort study ,Cancer ,Multidisciplinary ,BRCA1 Protein ,business.industry ,Obstetrics ,Odds ratio ,Middle Aged ,medicine.disease ,Prophylactic Mastectomy ,030220 oncology & carcinogenesis ,Female ,business ,Mastectomy - Abstract
Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987–2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie’s announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11–54) days after the index cancer surgery. Rates of CRRM doubled following AJ’s news, from 23.9% pre-AJ to 50.0% post AJ (p p p = 0.040), and to increase with the estimated lifetime risk of breast cancer (p p = 0.015) on univariable analysis. After adjusting for these factors, the step-change increase in CRRM rates post-AJ remained significant (odds ratio: 9.61, p
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- 2021
26. Gynaecomastia: when and why to refer to specialist care
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Hannah L Bromley, Ashu Gandhi, Matthew Rowland, Nigel Lord, Rajiv V. Dave, and Paul Wright
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Male ,Pediatrics ,medicine.medical_specialty ,Referral ,media_common.quotation_subject ,Physical examination ,Asymptomatic ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Pathological ,media_common ,medicine.diagnostic_test ,business.industry ,030503 health policy & services ,Testosterone (patch) ,body regions ,Etiology ,Gynecomastia ,Age of onset ,medicine.symptom ,Worry ,0305 other medical science ,Family Practice ,business - Abstract
Gynaecomastia is the commonest male breast complaint. Most cases are benign but the condition may signify a serious underlying illness. The challenge in primary care is to identify which patients with gynaecomastia are at greatest risk of pathological aetiology, so that they may be offered prompt specialty-appropriate referral and treatment. This article offers guidance on the assessment and management of patients with gynaecomastia, including when and why to refer to secondary care. Gynaecomastia refers to the enlargement of male glandular breast tissue. The condition develops because of an imbalance in the male oestrogen:testosterone ratio from a relative oestrogen excess or testosterone deficiency. Pseudo-gynaecomastia is caused by an excess of adipose tissue and does not warrant investigation or treatment. Gynaecomastia is frequently observed in general practice. Prevalence is between 35%–65% in males aged 50–69 years in the UK.1 Patients typically describe a soft swelling in one or usually both breasts. Tenderness, social embarrassment, or worry about cancer are typical reasons for presentation to primary care. Other men are asymptomatic and gynaecomastia may be noted incidentally on physical examination of the chest. Physiological gynaecomastia is common in newborns, adolescence, and senility. Most do not require investigation or referral. Neonatal gynaecomastia arises from the placental transfer of oestrogen. Over half of all adolescent boys will experience transient gynaecomastia during puberty due to a lag in testosterone secretion, with median age of onset at 14 years.2 Physiological gynaecomastia is common among males aged >50 years as testosterone levels fall with increasing age. Adult gynaecomastia is most commonly idiopathic (Figure 1). Male …
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- 2021
27. Uptake and efficacy of bilateral risk reducing surgery in unaffected female
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Ruta, Marcinkute, Emma Roisin, Woodward, Ashu, Gandhi, Sacha, Howell, Emma J, Crosbie, Julie, Wissely, James, Harvey, Lindsay, Highton, John, Murphy, Cathrine, Holland, Richard, Edmondson, Richard, Clayton, Lester, Barr, Elaine F, Harkness, Anthony, Howell, Fiona, Lalloo, and D Gareth, Evans
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Adult ,Aged, 80 and over ,Ovarian Neoplasms ,Heterozygote ,Adolescent ,Genes, BRCA2 ,Genes, BRCA1 ,Salpingo-oophorectomy ,Breast Neoplasms ,Prophylactic Surgical Procedures ,Middle Aged ,Risk Assessment ,Young Adult ,Prophylactic Mastectomy ,Humans ,Female ,Prospective Studies ,Aged ,Follow-Up Studies - Abstract
Women testing positive forWomen were prospectively followed up from positive genetic test (GT) result to censor date. χ² testing compared categorical variables; Cox regression model estimated HRs and 95% CI for BC/ovarian cancer cases associated with RRS, and impact on all-cause mortality; Kaplan-Meier curves estimated cumulative RRS uptake. The annual cancer incidence was estimated by women-years at risk.In total, 887 women were included in this analysis. Mean follow-up was 6.26 years (range=0.01-24.3; total=4685.4 women-years). RRS was performed in 512 women, 73 before GT. Overall RRM uptake was 57.9% and RRSO uptake was 78.6%. The median time from GT to RRM was 18.4 months, and from GT to RRSO-10.0 months. Annual BC incidence in the study population was 1.28%. Relative BC risk reduction (RRM versus non-RRM) was 94%. Risk reduction of ovarian cancer (RRSO versus non-RRSO) was 100%.Over a 24-year period, we observed an increasing number of women opting for RRS. We showed that the timing of RRS remains suboptimal, especially in women undergoing RRSO. Both RRM and RRSO showed a significant effect on relevant cancer risk reduction. However, there was no statistically significant RRSO protective effect on BC.
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- 2020
28. Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction
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Cliona C. Kirwan, J. Wisely, Ashu Gandhi, Fiona Lalloo, P. Duxbury, Anthony Howell, John Murphy, D. G. R. Evans, Thomas E. Clancy, and Philip Foden
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medicine.medical_specialty ,Mammaplasty ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,Internal medicine ,medicine ,Humans ,Patient Reported Outcome Measures ,Family history ,Mastectomy ,business.industry ,Perioperative ,medicine.disease ,Surgery ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Quality of Life ,Anxiety ,Patient-reported outcome ,Female ,medicine.symptom ,Breast reconstruction ,business ,Psychosocial - Abstract
Summary Background Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. Methods We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. Results Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. Conclusion We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
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- 2020
29. Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer
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Rajiv V. Dave, S. Cheung, Mark Sibbering, Olive Kearins, Ashu Gandhi, and Jacquie Jenkins
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medicine.medical_specialty ,medicine.medical_treatment ,Sentinel lymph node ,Breast Neoplasms ,030230 surgery ,Mastectomy, Segmental ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Breast-conserving surgery ,Humans ,Mass Screening ,Neoplasm Invasiveness ,Lymph node ,Early Detection of Cancer ,Mastectomy ,Aged ,business.industry ,Sentinel Lymph Node Biopsy ,General Medicine ,Nomogram ,Middle Aged ,medicine.disease ,Tumor Burden ,Axilla ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Lymph Node Excision ,Female ,Original Article ,Radiology ,business ,Mammography - Abstract
Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.
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- 2020
30. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction
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S Potter, A Trickey, T Rattay, R L O'Connell, R Dave, E Baker, L Whisker, J Skillman, M D Gardiner, R D Macmillan, C Holcombe, Nicola L P Barnes, Jane Blazeby, Elizabeth Conroy, Rajiv V Dave, Matthew D Gardiner, Adrian Harnett, Chris Holcombe, Shelley Potter, Tim Rattay, Joanna Skillman, Paula Williamson, Rajgopal Achuthan, Shweta Aggarwal, Elizabeth Baker, Naren Basu, Lisa Brock, Patricia Fairbrother, Charlotte Ives, Abhilash Jain, Baek Kim, R Douglas Macmillan, John Murphy, Dennis Remoundos, Richard Sutton, Adam Trickey, Philip Turton, Kathryn Williams, Alain Curnier, Amir Tadros, Ivan Depasquale, Mairi Fuller, Roger Bourne, Steven Heys, Ishrak Hamo, Fatima Aloraifi, Laura Fopp, Radhika Bali, Sarah Bache, Sarah L Benyon, Michael S Irwin, Amit Agrawal, Charles M Malata, Claire Murphy, Adam Misky, Dennis Wayne Chicken, Nassreen Abdullah, Arnold D K Hill, Carolyn Cullinane, Gareth Irwin, Stuart A McIntosh, Sigi Refsum, Samantha Sloan, Peter Mallon, Chiara Sirianni, Ilyas Khattak, Geerthan Nagachandra, Pasupathy Kiruparan, Debasish Debanth, Simon Davey, Terry-Ann Curran, Matilda Svenning, Sasirekha Govindarajulu, Zenon Rayter, Rachel Ainsworth, Simon Cawthorn, Ajay Sahu, Sherif Wilson, Elena Prousskaia, Antonello Accurso, Nicola Rocco, Rosa Di Micco, Gennaro Limite, Raffaele Ceccarino, Raffaele Liccardo, Guido Coco, Metin Nizamoglu, Mary Morgan, Venkat Ramakrishnan, Giuseppe Catanuto, Alex Wilkins, Penelope McManus, Peter Kneeshaw, Kartikae Grover, Tapan Mahapatra, Brendan Wooler, Bilal Elahi, Naila Ihsan, Alexandra Bucknor, Dimitris Reissis, Judith Hunter, Simon Wood, Navid Jallali, Francis P Henry, Liaquat S Verjee, Jason Lee, Shazia M Khan, Iman Azmy, Julia Massey, Ciaran Hollywood, Michael Oluwajana, Sonia Bathla, Joanna Seward, Claudia Harding-MacKean, Risha Lane, Kothandaraman Murali, Bashishta Biswas, Pawel Trapszo, Seema Seetharam, Katy Kennedy, Louise Alder, Tomasz Graja, Khalid Amin, Jalal Kokan, Chandeena Roshanlall, Emma Gill, Dhananjay Kulkarni, J M Dixon, Oliver Young, Talha Saleem, M Biddle, Marie Kearns, Eva Weiler-Mithoff, Ben Chew, Andy Malyon, John Scott, David McGill, Iain Mackay, Salena Bains, Sara Barrows, Simon Pilgrim, Sheila Shokuhi, Kelly Lambert, Frances Kenny, Kalliope Valassiadou, Monika Kaushik, Jaroslaw Krupa, Dimitris Dragoumis, Pavlos Lampropoulos, Sarah Moss, Haitham Khalil, Anwar Haq, Balapathiran Balasubramanian, Petros Charalampoudis, Hisham Hamed, Ashutosh Kothari, Tibor Kovacs, Michael Douek, Iftikhar Mehmood, Biswajit Ray, Matthew Adelekan, Laura Humphreys, Salim Tayeh, Christina Choy, Laila Parvanta, Silvia Michieletto, Tania Saibene, James O'Brien, Sue Down, Sarah Downey, Jerome Pereira, A S Sami, Anzors Gvaramadze, Jibril A Jibril, Dinesh Thekkinkattil, S Udayasankar, Saira Khawaja, Yousef Shariaha, Simon Holt, Ruth James, Hirah Rizki, Katharine Kirkpatrick, Duraisamy Ravichandran, Deepak Shrestha, Ellora Barua, Deepika Akolekar, Ahmed Hamad, Eleftheria Kleidi, Susan Hignett, Vanessa Pope, Salma Naseem, Jennifer Isherwood, Rachel Soulsby, Amanda Taylor, Kian Chin, Dai Nguyen, Francesca Guest, Amanda Thorne, Valentina Lefemine, Chris Kirchhoff, Declan C Murphy, Michelle Lo, Ruth Harcourt, Simon J Pain, Maged I Hussien, Katalin Zechmeister, E M Sassoon, Andrea Figus, Richard M Haywood, Rozina Ali, Susanna Alexander, Konstantinos Geropantas, Daniel Epurescu, Rebecca Lewis, Oladapo Fafemi, Jasdeep Gahir, Tasha Gandamihardja, Jennett Kelsall, Nazli Muhibullah, Charlene Otieno, Fayyaz Mazari, Marta Dauria, Lisa Whisker, Douglas Macmillan, Eleanor Gutteridge, Tuabin Rasheed, Hazem Khout, Kristjan Asgeirsson, Stephen McCulley, Maria Donatella Mariniello, Manuela Roncella, Matteo Ghilli, Livio Colizzi, Elena Rossetti, Lo Russo Marzia, Loredana Fustaino, Alessandro Quattrini Li, Kate L Harvey, Rebecca Windle, Dionysios Dennis Remoundos, Pankaj Roy, Gael MacLean, Asha Adwani, Elena Popa, Steven Goh, Geeta Shetty, Sarah Clark, Lorenzo Bernaudo, Avi Agrawal, Lucy Mansfield, Sally Tebbal, Ashraf Patel, Veronica Grassi, Ojas Pujji, Kathryn Hamnett, Emily Granger, Michael Durbar, Panagiotis Pikoulas, Clare Garnsey, Philip Walker, Angela J Vollermere, Ioannis Michalakis, Robin Jones, Mina Youssef, Mohammad Masood, Julie Dunn, Sisse Olsen, Douglas Ferguson, Rachel Tillett, Anna Allan, Alex Woollard, Rebecca Canny, Alexander Woollard, Afshin Mosahebi, Stephen Hamilton, Jagdeep Chana, Nilesh Sojitra, Ibby Younis, Dick Rainsbury, Natalie Chand, Vasileios Kalles, Anne Stebbing, Kevin Harris, Siobhan Laws, Anne Tansley, Geraldine Mitchell, Emma de Sousa, Julia Henderson, Mysore Chandrashekar, Bernadette Pereira, Chloe Constantinou, Dalia Elfadl, Foivos Irakleidis, Izaro Hernan, Miriam Byrne, Rachel O'Connell, Jennifer Rusby, Peter Barry, Katerine Krupa, William Allum, Fiona MacNeill, Nicola Roche, Gerald Gui, Kelvin Ramsey, Paul Harris, Stuart James, Jamie McIntosh, Nicola Laurence, Louise MacLennan, Robert Milligan, Henry Cain, Adam Critchley, Joe O'Donoghue, Loraine Kalra, Nick Collis, Gina Weston-Petrides, Roanne Fiddes, Victoria Brown, Anna Aertssen, Diana Slade-Sharman, Mansoor Khan, Caroline McGuiness, Vittoria Amorosi, Santanelli di Pompeo Fabio, Georgios Exarchos, Natasha Jiwa, Jennifer Hu, Serena Ledwidge, Laura Johnson, Anthony Peel, Naseem Dhooma, Eric Farrell, Liam Devane, Ruth Tevlin, Enda McDermott, Ruth Prichard, Denis Evoy, Jane Rothwell, James Geraghty, Colin Morrison, Catriona Lawlor, Fiona Langlands, Lauren Taylor, Raj Achuthan, Kieran Horgan, Shireen Mckenzie, Brian Hogan, Mark Lansdown, Channegowda Navin, Liz Sherwin, Caroline Mortimer, Neeraj Garg, Rahma Adam, Tahera Arif, Zbigniew Kryjak, Deedar Ali, Ravi Sowdi, Elena Fage, Senthurun Mylvaganam, Pilar Matey, Raghavan Vidya, Tapan Sircar, Oubida Asaad, Pud Bhaskar, Matei Dordea, Ada Chrysafi, Damian McCartan, Rajiv Dave, Rachel Foster, Rebecca Wilson, Sylvia Okwemba, Yousef Majeed, Ciara O'Brien, Vinod Mathen, Nicola Barnes, Ashu Gandhi, James Harvey, Cliona C Kirwan, Richard Johnson, Krupali Patel, Maria Dalmau Ribas, Natali Vigneswaran, Tom Challoner, Alan Park, Maged Rizkalla, Abigail Tomlins, Kat McEvoy, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan, Robert Kirby, Sladana Bajrusevic, Joseph Maalo, Michalis Charalambous, Lee Min Lai, Kelvin Chong, Simon Thomson, Sherif Monib, Leena Chagla, Riccardo Audisio, Rieka Taghizadeh, Azhar Iqbal, Karen James, Maria Callaghan, Shabbir Poonawala, Jonathan Lund, Raman Vinayagam, Steven Thrush, Rachel Bright Thomas, Michelle Mullan, Jevan Taylor, Ryo Yoshimura, Tom Mathew, Ben Mancey Jones, Kailas Munot, Rana Nasr, Jenny Piper, Deena El-Sharief, Mohammed Mustafa, Caitlin MacLeod, Elizabeth Smyth, Nina Saeed, Yazan Masannat, Amir Tan Mohd-Amin, Sam Sloan, Stuart McIntosh, Abdulla Ibrahim, Rathi Rathinaezhil, Eiman Khalifa, Penny McManus, Alexander Leeper, Jennifer McIlhenny, James Mansell, Keith Ogsto, Laszlo Romics, Shelia Shokuhi, Xiang Wei Jonathan Lee, Asmaa Al-Allak, Clare Fowler, Eleanore Massey, Fiona Court, Richard Hunt, Sarah Vestey, Mohsen Elgammal, Arish Noshirwani, Tehera Arif, Farah H Syed, Gazalla Safdar, Mohammed El-Abbar, Fiona Hogg, Pauline McGee, Vassilis Pitsinis, Jenny Smith, Sundus Makkiyah, Syed Mustafa, Dana Photiou, Ellie Gutteridge, Georgette Oni, Kelly Hallam, Kristjan Asgeirron, Marta D'Auria, Samim Al-zubaidi, James Bailey, Alexandra Tenovici, Dionysios-Dennis Remoundos, Nikos Chaidos, Oana Predescu, Jan Rezulski, Tholkifl Abdullah, Sujatha Udayasankar, Adam Talbot, Jagdeep Singh, Amy Smith, Angela Volleamere, Sarah Dean, Lashan Peiris, Olivia Sjokvist, Emma De Sousa, Aikaterini Micha, Amy Godden, Katherine Krupa, John Henton, Ruth Bennett, Stewart Nicholson, Guido Paolini, Luca Francesco Renzi, Santanelli Di Pompeo, Vitto Ria, Rebecca S Lewis, Sirwan Hadad, Anup Sharma, Delia Toomey, Dibyesh Banerjee, Sarah Shuk Kay Tang, Shireen McKenzie, Tanvir Ahmad, Kate Williams, Mohammed Absar, Nabila Nasir, Igor Jerzy Rychlik, Lynn Darragh, Ruth Johnston, Stephen Kirk, Jacqueline Rees-Lee, Michael Green, Abhishek Sharma, Jia Choong, Zaker Ullah, Ommen Koshy, Tamara Kiernan, Ajay Ashok Bhojwani, Rachel Bright-Thomas, Ged Byrne, Ibrahim Ibrahim, Lyndsey Highton, Owen Morris, Sumohan Chatterjee, Cliona Kirwan, Ben Mancey-Jones, Denna El Sharief, and Richard Frame
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Adult ,therapeutic mammaplasty ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030230 surgery ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,breast cancer ,0302 clinical medicine ,Breast cancer ,cohort study ,medicine ,Adjuvant therapy ,Humans ,breast reconstruction ,Young adult ,Mastectomy ,collaborative ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Proportional hazards model ,business.industry ,Immediate breast reconstruction ,oncological safety ,conservative treatment ,mastectomy ,Middle Aged ,medicine.disease ,Surgery ,Logistic Models ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Breast reconstruction ,business ,Cohort study - Abstract
Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment.TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.La mamoplastia terapéutica (therapeutic mammaplasty, TM) puede ser una alternativa a la mastectomía, pero hay pocos estudios bien diseñados que hayan evaluado el éxito de esta estrategia o hayan comparado los resultados a corto plazo de la TM con la mastectomía con o sin (+/-) reconstrucción mamaria inmediata (immediate breast reconstruction, IBR). Para comparar la seguridad y los resultados a corto plazo de la TM y la mastectomía +/- IBR se combinaron los datos de los estudios nacionales iBRA-2 y TeaM. MÉTODOS: En el estudio TeaM se identificó el subgrupo de pacientes al que se realizó una TM para evitar la mastectomía y se compararon los datos demográficos, las complicaciones, los resultados oncológicos y el tratamiento adyuvante con las pacientes sometidas a mastectomía +/- IBR del estudio iBRA-2. La variable principal fue el porcentaje de éxito de la cirugía conservadora de mama en el grupo TM. Las variables secundarias fueron las complicaciones postoperatorias y el intervalo de tiempo hasta el inicio del tratamiento adyuvante.Se incluyeron en el análisis 2.916 pacientes (TM n = 376; mastectomía n = 1.532; IBR n = 1.008). La TM era más frecuente en pacientes obesas o en las sometidas a cirugía bilateral en comparación con las pacientes con IBR. Sin embargo, las pacientes sometidas a una mastectomía +/- IBR tenían más probabilidades de desarrollar complicaciones que las del grupo TM (TM n = 79, 21,0%; mastectomía n = 570, 37,2%; mastectomía y IBR n = 359, 35,6%; P 0,001). La conservación de la mama fue posible en el 87% de las pacientes con TM y el procedimiento no retrasó el inicio del tratamiento adyuvante. CONCLUSIÓN: La TM puede permitir que pacientes de alto riesgo que no serían candidatas a IBR eviten la mastectomía de una forma segura. Se necesitan más trabajos para comparar los resultados percibidos por las pacientes y los estéticos de las diferentes estrategias terapéuticas y establecer la seguridad oncológica a largo plazo.
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- 2020
31. Publisher Correction: Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
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Shelley Potter, Cliona C. Kirwan, Kieran Horgan, Tim Rattay, Jamie J Kirkham, Elizabeth Camacho, Rachel O'Connell, Rajiv V. Dave, orcid, Baek Kim, Christopher W. J. Cartlidge, Alona Courtney, Daniel R. Leff, Ellen Copson, Vicky P. Taxiarchi, Patricia Fairbrother, Stuart McIntosh, Ashu Gandhi, orcid: X, Charlotte E. Coles, Raghavan Vidya, Chris Holcombe, Ramsey I. Cutress, and Nisha Sharma
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Oncology ,Quality of life ,Adult ,Cancer Research ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Breast Neoplasms ,Phase (combat) ,Cohort Studies ,Breast cancer ,Internal medicine ,Pandemic ,medicine ,Humans ,Aged ,Aged, 80 and over ,business.industry ,SARS-CoV-2 ,Correction ,COVID-19 ,Health care economics ,Middle Aged ,medicine.disease ,Alert level ,Health policy ,Surgical oncology ,Practice Guidelines as Topic ,Female ,business - Abstract
The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions.This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated 'standard' or 'COVID-altered', in the preoperative, operative and post-operative setting.Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had 'COVID-altered' management. 'Bridging' endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2-9%) using 'NHS Predict'. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.The majority of 'COVID-altered' management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
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- 2021
32. 04. MAMMA (Mastitis and Mammary abscess Management Audit): Phase 1 interim results
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Alona Courtney, Ruth Parks, Nur Nurmahomed, Ruth Brown, Rachel O'Connell, Rajiv Dave, Marianne Dillon, Hiba Fatayer, Rachel Gallmore, Ashu Gandhi, Matthew Gardiner, Victoria Harmer, Lyndsey Hookway, Gareth Irwin, Charlotte Ives, Helen Mathers, Juliette Murray, Peter O’Leary, Neill Patani, Sophie Paterson, Shelley Potter, Ruth Prichard, Giovanni Satta, T.G. Teoh, Paul Ziprin, Alexander Wilkins, Daniel R. Leff, and null MAMMA Research Collaborative
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Oncology ,Surgery ,General Medicine - Published
- 2021
33. P073. Evaluating the impact of a gynaecomastia assessment and treatment infographic into primary care in greater Manchester
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Hannah Bromley, Michael Preston, Leonhard Walter, Rajiv Dave, Nigel Lord, Paul Wright, Matthew Rowland, and Ashu Gandhi
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Oncology ,Surgery ,General Medicine - Published
- 2021
34. P192. Does mastectomy reduce overall survival in early stage breast cancer?
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John Murphy and Ashu Gandhi
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Oncology ,Surgery ,General Medicine - Published
- 2021
35. P110. A new nurse led service to optimise endocrine therapy for perimenopausal breast cancer patients
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Nicola Stubbs and Ashu Gandhi
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Oncology ,Surgery ,General Medicine - Published
- 2021
36. 16. Efficient management of new patient referrals: The safe introduction of an Advanced Nurse Practitioner (ANP) led telephone breast pain service
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Claire Robinson, Katy Ellis, Hiba Fatayer, Nader Touqan, and Ashu Gandhi
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Oncology ,Surgery ,General Medicine - Published
- 2021
37. Correction: Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
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Baek Kim, Cliona C. Kirwan, Ellen Copson, Raghavan Vidya, Tim Rattay, Christopher W. J. Cartlidge, Kieran Horgan, Chris Holcombe, Ramsey I. Cutress, Shelley Potter, Daniel R. Leff, Alona Courtney, orcid, Jamie J Kirkham, Charlotte E. Coles, Patricia Fairbrother, Elizabeth Camacho, Ashu Gandhi, orcid: X, Vicky P. Taxiarchi, Nisha Sharma, Stuart McIntosh, Rachel O'Connell, and Rajiv V. Dave
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Oncology ,Quality of life ,Cancer Research ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Correction ,Health care economics ,medicine.disease ,Alert level ,Phase (combat) ,Health policy ,Breast cancer ,Internal medicine ,Surgical oncology ,Pandemic ,medicine ,business - Published
- 2021
38. Axillary Surgery Following Neoadjuvant Chemotherapy - Multidisciplinary Guidance From the Association of Breast Surgery, Faculty of Clinical Oncology of the Royal College of Radiologists, UK Breast Cancer Group, National Coordinating Committee for Breast Pathology and British Society of Breast Radiology
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J Doughty, Amit Goyal, Anthony J. Maxwell, Andreas Makris, Ashu Gandhi, Elena Provenzano, Charlotte E. Coles, Coles, Charlotte [0000-0003-4473-8552], and Apollo - University of Cambridge Repository
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Adult ,medicine.medical_specialty ,Breast Neoplasms/pathology ,Breast surgery ,medicine.medical_treatment ,Breast Neoplasms ,sentinel node biopsy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Multidisciplinary approach ,Biopsy ,medicine ,Sentinel Lymph Node Biopsy/methods ,Humans ,Radiology, Nuclear Medicine and imaging ,Axillary radiotherapy ,Neoadjuvant therapy ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,Sentinel Lymph Node Biopsy ,Neoadjuvant Therapy/methods ,Sentinel node ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,United Kingdom ,Axilla ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Lymph Nodes/pathology ,Female ,Radiology ,Lymph Nodes ,business ,axillary surgery ,neoadjuvant chemotherapy - Abstract
AIMS: These multidisciplinary guidelines aim to provide clinically helpful, evidence-based recommendations on the surgical management of the axilla in patients who have received neo-adjuvant chemotherapy for early breast cancer.MATERIALS & METHODS: Following a review of published evidence, a writing group representing all disciplines quorate within a breast cancer multidisciplinary meeting prepared the guidelines.KEY RECOMMENDATIONS: In patients presenting with clinically node negative axillae, sentinel node biopsy (SNB) may be performed prior to or on completion of neo-adjuvant chemotherapy (NACT). In patients presenting with clinically node positive axillae, SNB may be safely considered following completion of NACT. Four nodes should be removed with dual mapping. If evidence of complete pathological response of previous metastases is seen, axillary radiotherapy may be offered. If residual cancer (isolated tumour cells, micro- or macrometastes) is seen within the SNB, offer axillary node dissection.
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- 2019
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39. Predictors of weight gain in a cohort of premenopausal early breast cancer patients receiving chemotherapy
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Ashu Gandhi, Katharine Sellers, Julie Morris, Lorraine Durcan, Diana Eccles, Anthony Howell, D. Gareth Evans, Sacha J Howell, Sarah McDiarmid, Michelle Harvie, and Ellen Copson
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Adult ,medicine.medical_specialty ,Waist ,medicine.medical_treatment ,Breast Neoplasms ,Weight Gain ,chemotherapy ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,breast cancer ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Chemotherapy ,premenopausal ,Manchester Cancer Research Centre ,business.industry ,ResearchInstitutes_Networks_Beacons/mcrc ,Body Weight ,weight gain ,General Medicine ,medicine.disease ,Obesity ,Premenopause ,Quartile ,Chemotherapy, Adjuvant ,Obesity, Abdominal ,030220 oncology & carcinogenesis ,Cohort ,Female ,Surgery ,Neoplasm Recurrence, Local ,medicine.symptom ,business ,Body mass index ,Weight gain - Abstract
Aim In breast cancer patients, post chemotherapy weight gain is linked with increased risk of cancer recurrence. We prospectively studied a cohort of premenopausal women receiving contemporary chemotherapy following a diagnosis of breast cancer to examine factors predicting weight increase. Methods Between May 2005 and January 2008, 523 patients enrolled into the Prospective Outcomes in Sporadic versus Hereditary breast cancer study entered this sub-study comparing weight prior to chemotherapy and weight and waist/hip measurements 12-months following chemotherapy. Results Data from 380 patients were available. Mean (standard deviation [SD]) pre-treatment body mass index (BMI) was 26.3 [5.6] kg/m2; 30% women gained > 5% body weight during the study period. Lower BMI at diagnosis predicted greater subsequent post treatment weight gain (4.3% relative weight gain for those in the 1st quartile of BMI compared to 0.8% for those in the 4th quartile; r=-0.22; p88cm). Conclusions Almost a third of premenopausal patients receiving adjuvant chemotherapy for breast cancer will gain clinically significant weight and over 40% will have central obesity 12-months following diagnosis. A greater weight gain is predicted by lower pretreatment BMI.
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- 2019
40. Implant-based breast reconstruction with Artia™ tissue matrix
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Ashu Gandhi, Lyndsey Highton, Bilal Fakim, John Murphy, and Richard Johnson
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Adult ,medicine.medical_specialty ,Erythema ,Swine ,medicine.medical_treatment ,Breast Implants ,Mammaplasty ,Breast Neoplasms ,030230 surgery ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,law ,medicine ,Animals ,Humans ,Acellular Dermis ,Prospective Studies ,Prospective cohort study ,Mastectomy ,Aged ,Aged, 80 and over ,business.industry ,Wound dehiscence ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Breast implant ,Female ,Implant ,medicine.symptom ,Breast reconstruction ,Complication ,business ,Follow-Up Studies - Abstract
Summary Background In 2015, Artia™ (LifeCell, NJ), a new porcine acellular dermal matrix (ADM), was introduced at our unit. As there is lack of clinical studies on its use in breast reconstruction, the purpose of this prospective study was to assess outcome data for patients who underwent Artia™-assisted breast reconstruction. We compared these data with those of other studies of non-human ADMs in widespread use from the literature. Methods All consecutive patients who underwent Artia™-assisted breast reconstruction between July 2016 and February 2018 were identified. A prospective database was maintained, including data of patient demographics, type of reconstruction, type of implant, oncological data if applicable, complication rates and adjuvant treatment delays. Results Fifty-one patients undergoing 83 implant-based breast reconstructions with Artia™ were included in the study. Of the 83 reconstructions, 62% were performed following risk-reducing mastectomy, 28% following therapeutic mastectomy and 10% for revision procedures. After a mean 276-day follow-up period, the overall complication rate was 10.8%, including 6 breasts (7.2%) developing seromas requiring aspiration, 1 breast developing a haematoma (1.2%) and 2 implant losses (2.4%) in a single patient following neo-adjuvant chemotherapy. There were no cases of wound dehiscence or erythema/red breast syndrome. Conclusion This is one of the first studies demonstrating that Artia™-assisted implant-based breast reconstruction is associated with low and acceptable early complication rates. The results are promising and are comparable to our experience using established ADMs, with an implant loss rate of 4.9% across 500 ADM-assisted implant reconstructions.
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- 2019
41. Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)
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Rosemary Greenhalgh, Sally Cole, Fiona Lalloo, Penelope Hopwood, Andrew D Baildam, Mary Pegington, Jenny Affen, Andrew Maurice, D. Gareth Evans, Anthony J. Maxwell, Anthony Howell, Julie Wisely, Lester Barr, Julia Wiseman, Sacha J Howell, Elaine F. Harkness, Ashu Gandhi, Andrea Wilding, Mary Wilson, David P. French, Michelle Harvie, and Susan M. Astley
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Risk ,Cancer Research ,medicine.medical_specialty ,Breast surgery ,medicine.medical_treatment ,Family history ,Population ,Anastrozole ,lcsh:RC254-282 ,Article ,03 medical and health sciences ,Breast cancer ,breast cancer ,0302 clinical medicine ,prevention ,medicine ,030212 general & internal medicine ,genes ,education ,risk ,family history ,education.field_of_study ,Manchester Cancer Research Centre ,business.industry ,Obstetrics ,Prevention ,ResearchInstitutes_Networks_Beacons/mcrc ,screening ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Genes ,Oncology ,030220 oncology & carcinogenesis ,Screening ,Population Risk ,business ,Risk assessment ,Tamoxifen ,medicine.drug - Abstract
Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987&ndash, 2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (&ge, 30% lifetime risk), 37.7% at moderate risk (17&ndash, 29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14&ndash, 27% entered various lifestyle studies. From 1992&ndash, 2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention, 10.8% women took up the offer of such treatment between 2013&ndash, 2020. Since 1994, 7164 eligible women at &ge, 25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
- Published
- 2020
42. Variations in single/two stage thyroidectomies for cancer may be due to differences in thyroid fine needle cytology provision
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Beng K Yap, B Ranganathan, Ashu Gandhi, S. A. Thiryayi, and M Rowland
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endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Biopsy, Fine-Needle ,Thyroid Gland ,Diagnosis, Differential ,symbols.namesake ,Cytology ,medicine ,Humans ,Prospective Studies ,Thyroid Neoplasms ,Stage (cooking) ,Total thyroidectomy ,Obstetrics ,business.industry ,Thyroid ,Thyroidectomy ,Reproducibility of Results ,Cancer ,General Medicine ,medicine.disease ,Surgery ,Bonferroni correction ,medicine.anatomical_structure ,Oncology ,symbols ,Analysis of variance ,business - Abstract
Recommended treatment for thyroid cancers10 mm is single stage total thyroidectomy (SST). Cancers diagnosed by diagnostic lobectomy may need completion surgery resulting in two stage thyroidectomies (TST). We noticed significant variation in numbers of SST and TST between hospitals within our cancer network and explored reasons for this using a prospective database containing all cases from 2004 to 2011 (n = 1030). We therefore conducted a survey of thyroid cytology provision across the network during 2010-2011.A central university hospital with the largest caseload (21.5% of total) was chosen as "benchmark". Of 14 remaining hospitals 3 were excluded from analysis due to low thyroid operation numbers and the remaining compared with benchmark. We used individual chi-squared tests with Bonferroni correction to explore variation in expected and observed numbers of SST/TST. Analysis of variance (ANOVA) was used to examine reasons for observed differences.Significant variance in SST/TST was seen between hospitals (p0.00001). Three hospitals had frequencies of SST statistically similar to reference hospital; each reported 201-300 thyroid cytology cases during the survey period. The remaining 8 had lower rates of SST, the 2 lowest performing hospitals having SST rates of 11% (p = 0.0004) and 9% (p0.0001). These eight hospitals reported fewer than 200 cytology cases each, shared amongst 4-7 pathologists per site. Differences were unrelated to patient age, gender, tumour histology or stage (ANOVA). Only the reference hospital had specialist cytopathologists.Variation in thyroid cytology provision may increase TST rates. Thyroid cytology should be concentrated in high volume centres with specialist thyroid cytopathologists.
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- 2015
43. Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: A survey of UK breast surgeons
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Ashu Gandhi, Cliona C. Kirwan, Yogesh Jain, James Harvey, and Paula Duxbury
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Male ,medicine.medical_specialty ,Attitude of Health Personnel ,Mammaplasty ,Breast surgery ,medicine.medical_treatment ,Clinical Decision-Making ,Breast Neoplasms ,Breast cancer ,Surveys and Questionnaires ,medicine ,Humans ,Mastectomy ,Surgeons ,Response rate (survey) ,Breast surgeons ,business.industry ,Patient Selection ,General surgery ,Cosmesis ,General Medicine ,medicine.disease ,Combined Modality Therapy ,United Kingdom ,Surgery ,Radiation therapy ,Female ,Radiotherapy, Adjuvant ,Breast reconstruction ,business - Abstract
Decision-making for women requiring reconstruction and post-mastectomy radiotherapy (PMRT) includes oncological safety, cosmesis, patient choice, potential delay/interference with adjuvant treatment and surgeon/oncologist preference. This study aimed to quantitatively assess surgeons' attitudes and perceptions about reconstructive options in this setting, and to ascertain if surgical volume influenced advice given. A questionnaire was sent to surgical members of the UK Association of Breast Surgery (ABS) in March-June 2014. The questionnaire elicited information on surgeon volume, reconstructive practice and drivers influencing decision-making. Response rate was 42% (148/355), representing 71% of UK breast units. Delayed breast reconstruction (DBR) was offered more commonly than immediate implant, delayed-immediate or immediate autologous reconstruction (p0.05). Cosmesis was thought to be equivalent between IBR and DBR by 15% of surgeons, and 26% believe IBR and DBR offer similar Health-related Quality of Life (HRQoL). Surgeon volume had no effect on reconstruction choice. Common decision-making drivers included negative effects of radiotherapy upon reconstructive and cosmetic outcome. The majority of surgeons (77%) believe the current evidence base is insufficient to guide decision-making. Despite surgeons believing that cosmesis and quality of life are not equivalent between IBR and DBR, DBR remains the commonest approach to this difficult clinical scenario. Surgeons perceive they are using a variety of newer techniques such as Delayed-Immediate Reconstruction and Acellular Dermal Matrices to try to ameliorate the effects of PMRT. This survey demonstrates that there is wide variation in reported surgical practice in this difficult setting. There is widespread acknowledgement of the lack of evidence to guide decision-making.
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- 2015
44. Abstract P2-06-02: Breast cancer stem-like cell activity correlates with tumour progression to metastasis but not with clinical or tumour characteristics
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Zahida Saad, Fran Shaw, Angélica Santiago-Gómez, Mohamed Absar, Cliona C. Kirwan, Ashu Gandhi, Robert Clarke, Bruno M Simões, Andrew M Wardley, Katherine Spence, Rachel Eyre, Sacha J Howell, Maria Bramley, Anne C Armstrong, Sumohan Chatterjee, Gillian Farnie, and D Alferez
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Cancer Research ,Pathology ,medicine.medical_specialty ,business.industry ,Cellular differentiation ,Cancer ,medicine.disease ,In vitro ,Metastasis ,Breast cancer ,Oncology ,In vivo ,Cancer stem cell ,medicine ,Cancer research ,Nottingham Prognostic Index ,business - Abstract
Introduction: Breast cancers exhibit cellular heterogeneity, containing both stem-like and more differentiated cells. The activity of cancer stem cells (CSC) is likely to be dependent on the microenvironment or niche. Using 158 patient tumour samples, correlations between niche-independent breast CSC activity and clinical and tumour characteristics were tested. Methods: 104 early breast cancer surgical samples and 54 unrelated metastatic samples from pleural or ascitic fluid were harvested. To test CSC activity, isolated cells were grown in both primary (formation) and secondary (self-renewal) mammosphere (MS) culture. Tumour initiating activity was also tested by transplanting breast cancer fragments or cells into the sub-cutaneous flanks of NSG mice (n=84 early and n=10 metastatic). Results: No correlation was found between MS growth, MS formation (%), MS self-renewal (%) or in vivo tumour initiation and breast cancer sub-type, grade, node status or Nottingham prognostic index. 33% of the samples that formed MS in vitro initiated tumours in vivo while only 9% that failed to form MS initiated tumour growth. Metastatic compared to early BC samples grew MS more frequently (53/54 compared to 81/104), and had a higher primary MS formation efficiency (1% vs 0.6%; P Conclusions: In summary, niche-independent breast CSC activity measured in vitro by MS assay and in vivo by xenograft growth is not directly correlated with standard clinical parameters. However, both in vitro and in vivo CSC activity are increased in metastatic samples. These results suggest that breast CSC activity is independent of other prognostic indicators but may predict for poor outcome tumours. Relapse free survival data are maturing and will be presented with analysis of primary tumour ALDH1 expression. Citation Format: Sacha J Howell, Denis Alferez, Katherine Spence, Rachel Eyre, Fran Shaw, Bruno Simoes, Angelica Santiago-Gomez, Maria Bramley, Mohamed Absar, Zahida Saad, Sumohan Chatterjee, Cliona Kirwan, Ashu Gandhi, Anne C Armstrong, Andrew M Wardley, Gillian Farnie, Robert B Clarke. Breast cancer stem-like cell activity correlates with tumour progression to metastasis but not with clinical or tumour characteristics [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-06-02.
- Published
- 2015
45. Abstract P2-14-09: Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy
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Cliona C. Kirwan, Nigel J Bundred, Paula Duxbury, Ashu Gandhi, and James Harvey
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Cancer Research ,Reconstructive surgery ,medicine.medical_specialty ,education.field_of_study ,business.industry ,medicine.medical_treatment ,General surgery ,Breast surgery ,Population ,Cosmesis ,medicine.disease ,Surgery ,Breast cancer ,Oncology ,Quality of life ,medicine ,business ,education ,Breast reconstruction ,Mastectomy - Abstract
Approximately 30-40% of women are not offered immediate breast reconstruction because the possibility of post-mastectomy radiotherapy (PMRT) is unknown at the time of mastectomy. Breast reconstruction may be delayed until final pathology is available and need for radiotherapy established. Surgical literature is replete with studies of varying quality, reporting complication rates for a range of reconstructive procedures, highlighting the need for surgical trials of reconstructive techniques in women at risk of PMRT. Decisions for these patients are complex, involving multiple clinicians including surgeons and oncologists. To inform a surgical trial design, we aimed to determine current UK surgical practice and gain an understanding of the drivers behind decision-making. Methods: A questionnaire, validated in a pilot population, was posted to Consultant members of the Association of Breast Surgery (UK). We collected data on current practice in conducting Delayed, Immediate and Delayed-immediate reconstructive surgery. We collated data on type and volume of procedure performed and factors affecting decision-making including delay to adjuvant treatment, risk of complications, perception of patients’ quality of life (QoL) and aesthetic satisfaction. Results: Of 355 surgeons, 130(37%) responded. Of these, 77% felt the current evidence base was not adequate to guide surgical decisions and 80% felt a need for further trials to guide best treatment. Despite a lack of scientific evidence demonstrating a difference in cosmesis or QoL between Immediate and Delayed reconstruction, 85% felt there is not equivalent cosmesis and 71% felt there is not equivalent QoL between the two groups. There is considerable heterogeneity in reconstructive approach to patients at risk of PMRT (Table 1). Delayed reconstruction remains the most popular option, being regularly used by 94% of surgeons despite only 34% of surgeons believing the majority of patients are satisfied with the approach. Significantly fewer surgeons perform Immediate implant based reconstruction (with or without ADM) than Delayed (p Table 1 No. of responses NeverSometimesOftenAlwaysDelayed5505119Immediate implant584181Immediate ADM+Implant45491452-stage (delayed-immediate) Expander to permanent reconstruction2855335Immediate Autologous2959227 The three most important drivers in making a reconstructive choice were 1. Effect of PMRT on the cosmetic result 2. Minimising risk of complications and avoiding delay to adjuvant treatment 3. Pre-operative uncertainty over the need for PMRT. Conclusions: Surgeons employ a variety of approaches to reconstruction in the face of PMRT, the most common approach being delayed reconstruction. Decision-making is based upon individual surgeon’s perception of risks including likely delay to adjuvant therapy and effect of PMRT on the reconstruction. Drivers appeared to be more surgeon-centred rather than patient-based. There is awareness of a lack of evidence to support decision-making and the need for high quality studies. Randomised clinical trials are needed to provide an evidence base for outcomes. Citation Format: James R Harvey, Nigel J Bundred, Cliona C Kirwan, Ashu Gandhi, Paula J Duxbury. Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-09.
- Published
- 2015
46. Thyroid incidentalomas discovered on positron emission tomography CT scanning – Malignancy rate and significance of standardised uptake values
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Damien Mullan, Ashu Gandhi, Beng K Yap, and Richard A. Brindle
- Subjects
Male ,medicine.medical_specialty ,Lymphoma ,Thyroid Gland ,Malignancy ,Multimodal Imaging ,Cohort Studies ,Fluorodeoxyglucose F18 ,Adenocarcinoma, Follicular ,medicine ,Carcinoma ,Humans ,Thyroid Neoplasms ,Thyroid cancer ,Aged ,Retrospective Studies ,Incidental Findings ,PET-CT ,medicine.diagnostic_test ,business.industry ,Thyroid ,Ultrasound ,Retrospective cohort study ,General Medicine ,medicine.disease ,Carcinoma, Papillary ,medicine.anatomical_structure ,Oncology ,Thyroid Cancer, Papillary ,Positron emission tomography ,Positron-Emission Tomography ,Female ,Surgery ,Radiology ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Aims Increasing use of 18F-Fluorodeoxy glucose (FDG) Positron Emission Tomography Computed Tomography (PET CT) has resulted in an increased frequency of incidentally discovered areas of focally increased FDG uptake within the thyroid gland – thyroid incidentalomas. We aimed to compare radiological characteristics of thyroid incidentalomas with cytology, histology and ultrasound findings. Materials and methods We examined all FDG PET CT scan reports for all patients undergoing this investigation over a 6 year period in a single tertiary cancer centre. All PET CT scans followed an agreed proforma allowing reports mentioning “thyroid” to be identified. Reports commenting on a positive finding within the thyroid gland were investigated further manually. Incidental mentions of thyroid with no underlying abnormality were discounted from analysis. Results In the study period, 7221 patients underwent FDG PET CT scanning in our unit. Within this group 75 (1%) showed diffuse FDG uptake and 81 (1.1%) showed focal uptake (thyroid incidentalomas). Only 30 patients (37%) with incidentalomas had further investigation and malignancy rate was 23% (7/30). Median Standardised Uptake Values (SUV) in malignant lesions was 9.9 (range 3.5–17.8) whilst in benign lesions and diffuse lesions it was 5.4 (2.8–32) and 4.2 (2.1–25.6) respectively ( p = 0.0013, Kruskal Wallis). Conclusion There remains a need to develop a standardised approach to the investigation and management of thyroid incidentalomas discovered on FDG PET CT scanning. Up to 1 in 4 of these patients will harbour thyroid malignancy.
- Published
- 2014
47. Optimum duration of neoadjuvant letrozole to permit breast conserving surgery
- Author
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Anthony Skene, Chris Andrews, Gerald Gui, Ashu Gandhi, Julie Doughty, Christopher R Wilson, Gillian Ellis, Robert Carpenter, Nuala Moss, and C. Cordiner
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,Antineoplastic Agents ,Breast Neoplasms ,Mastectomy, Segmental ,Breast cancer ,Internal medicine ,Nitriles ,medicine ,Breast-conserving surgery ,Humans ,Neoplasm Metastasis ,Adverse effect ,Neoadjuvant therapy ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Aromatase inhibitor ,Aromatase Inhibitors ,business.industry ,Letrozole ,Middle Aged ,Triazoles ,medicine.disease ,Neoadjuvant Therapy ,Surgery ,Clinical trial ,Treatment Outcome ,Female ,Neoplasm Grading ,business ,Mastectomy ,medicine.drug - Abstract
The aim of this multicenter, prospective, longitudinal phase IV study was to establish the optimal duration of neoadjuvant letrozole that would allow breast conservation surgery (BCS) in patients with early breast cancer who were initially unsuitable. Primary, invasive, estrogen-receptor- and/or progesterone-receptor-positive breast cancer patients, with large tumors (≥T2 i.e., >20 mm) not initially suitable for BCS, received 2.5 mg letrozole p.o. daily. Patients continued treatment until they became eligible for BCS, progressed, failed to meet criteria for BCS and withdrew for scheduled mastectomy, withdrew for other reasons, or completed 12 months of letrozole treatment without a BCS decision being made. A total of 146 patients were enrolled; seven patients who did not have a valid postbaseline tumor assessment were excluded from the final efficacy analysis. At study closure, 69 % of patients (96 of 139) were eligible for BCS. The median time to achieve a tumor response sufficient to allow BCS with neoadjuvant letrozole was 7.5 months (95 % CI 6.3–8.5 months). Letrozole was well tolerated, and most adverse events were mild-to-moderate (grade 1–2). The results from this trial suggest that extended letrozole therapy in the neoadjuvant setting (7.5 months), as opposed to conventional treatment of 4 months, is optimal to achieve maximum reduction in tumor volume sufficient for BCS.
- Published
- 2014
48. Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor
- Author
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Stefanie T. L. Pöhlmann, Ashu Gandhi, Christopher J. Taylor, Susan M. Astley, and Elaine F. Harkness
- Subjects
Adult ,medicine.medical_specialty ,Infrared Rays ,medicine.medical_treatment ,Breast Implants ,Mammaplasty ,Clinical Decision-Making ,Posture ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Predictive Value of Tests ,medicine ,Inframammary fold ,Humans ,Breast ,Mastectomy ,business.industry ,Reproducibility of Results ,Repeatability ,Organ Size ,Middle Aged ,Surgery ,Standard error ,030220 oncology & carcinogenesis ,Predictive value of tests ,Preoperative Period ,Linear Models ,Female ,Implant ,Anatomic Landmarks ,Breast reconstruction ,business ,Volume (compression) - Abstract
Summary Aims This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction. Methods Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions. Results The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R 2 = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R 2 = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%. Conclusion This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction.
- Published
- 2016
49. Acellular dermal matrix (ADM) assisted breast reconstruction procedures
- Author
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Kieran Horgan, L. Martin, Richard Johnson, J.M. O'Donoghue, Steven Thrush, and Ashu Gandhi
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medicine.medical_specialty ,business.industry ,Breast surgery ,medicine.medical_treatment ,Pectoralis major muscle ,General Medicine ,Audit ,Prosthesis ,Surgery ,Oncology ,Medicine ,Implant ,business ,Breast reconstruction ,Dermal matrix ,Tissue expansion - Abstract
Tissue expansion with delayed insertion of a definitive prosthesis is the most common form of immediate breast reconstruction performed in the United Kingdom. However, achieving total muscle coverage of the implant and natural ptosis is a key technical challenge. The use of acellular dermal matrices (ADM) to supplement the pectoralis major muscle at the lower and lateral aspects of the breast has been widely adopted in the UK, potentially allowing for a single stage procedure. There is however little published data on the clinical and quality criteria for its use, and no long term follow-up. The guidelines have been jointly produced by the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons and their aims are: to inform those wishing to undertake ADM assisted breast reconstruction and, to identify clinical standards and quality indicators for audit purposes. The guidelines are based on expert opinion of a multi-disciplinary working group, who are experienced in the technique, and a review of the published data.
- Published
- 2013
50. Contents Vol. 2, 3014
- Author
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Robert Burns, Yasuhiro Ito, Francesco Antonica, Eddy Rijntjes, Govindasamy Mugesh, Jean-Louis Wémeau, Josef Köhrle, Colm O'Herlihy, Akira Miyauchi, Jarrod J Homer, Ashu Gandhi, Brian Murby, Georg Brabant, Reinhardt Druck, Akihiro Miya, Salman Razvi, Sabine Costagliola, Leonidas H. Duntas, Yuuki Takamura, Ric Swindell, Kaoru Kobayashi, Beng Khiong Yap, Philip Moritz Scholz, Robert Opitz, Mitsuyoshi Hirokawa, Luigi Bartalena, Fabio Monzani, Nobuyuki Amino, Peter P.A. Smyth, Mengensatzproduktion, Neil Parrott, Tomonori Yabuta, Robin P. Peeters, Simon H. S. Pearce, Minoru Kihara, Sean Loughran, and Mitsuhiro Fukushima
- Subjects
Traditional medicine ,business.industry ,Endocrinology, Diabetes and Metabolism ,Medicine ,Physiology ,business - Published
- 2013
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