Background: The aim of the present study was to assess the frequency, clinical and pathologic characteristics and treatment modalities used for clinically locally advanced breast cancers (LABCs). Comparisons were made between cT4d and cT4abc LABCs.

Background: Adoption of neoadjuvant chemotherapy (NACT) in the “real world” has been poorly investigated. Aim of this study was to examine the rate of NACT in Italy, trends over time and determinants of therapeutic choices. Methods: Senonetwork, the recognized network of Breast Centers in Italy, has developed a voluntary national data warehouse with the aim to monitor and improve treatments quality. A retrospective analysis was conducted among 58,661 breast cancer (BC) patients treated between 2017 and 2022 by 24 high-volume Breast Centers participating in the project. Results: After subset exclusion, 37,215 primary BC patients were analysed, 32,933 underwent primary-breast-surgery and 4,282 underwent NACT. From 2017 to 2022, the overall NACT incidence increased particularly for HR-/HER2+, Triple-Negative, and HR+/HER2+ BC (p < 0.001). In cN + patients the recommendation to axillary lymph-node dissection after NACT decreased over time along with an increase of <4 lymph-nodes removed (p < 0.001). Immediate breast reconstruction and indication for nipple sparing mastectomy increased significantly over time (OR = 1.10, p = 0.011 and OR 1.14, p < 0.001, respectively). On multivariate analysis, there was a trend towards an increased adoption of conservative treatment for HR-/HER2+ (p = 0.01) and Triple Negative tumors (p = 0.06). Implementation of NACT varied significantly among Breast-Centers from 3.8 to 17.7 % (p < 0.001). Conclusion: The impact of NACT on the subsequent surgical management is substantial and continues to evolve over time, resulting in less-extensive surgery. Even among high-volume Centers NACT implementation rate is still highly variable. Although we registered a significant increase in its use during the study period, these results need to be further improved.

Background: The population of older women living with breast cancer is increasing worldwide. Despite the demonstrable benefits of post-mastectomy immediate breast reconstruction (PMIBR) in improving patients' quality of life and psychosocial well-being, some studies concluded that there is a lower uptake of PMIBR in older women versus younger women. This study uses real-world prospectively collected data from the European Society of Breast Cancer Specialists (EUSOMA), to explore whether there is such disparity seen in recent data, how we can attempt to overcome this, and to see if the disparity was influenced by the COVID-19 pandemic.

Introduction: Neoadjuvant therapy (NAT) may favor breast-conserving surgery (BCS) in non-metastatic breast cancer patients (NMBC), especially in those achieving tumor shrinkage. Deciding between BCS and mastectomy is not always straightforward in this population. We conducted a retrospective study to investigate drivers of surgical decision in NMBC patients with ypT0 after NAT. Additionally, we analyzed survival outcomes in ypT0 ypN0 (pCR) population.

Quality indicators (QI) are a specific tool to measure the quality of provided care. QI must be reliable, relevant, interpretable, actionable, and measurable. Contrarily to invasive breast cancer (IBC), the management of in situ breast cancer (BCIS) with adjuvant endocrine treatment (ET) remains controversial. The study aims to investigate the use of adjuvant ET in breast cancer in European (EU) countries, employing the European Society of Breast Cancer Specialists (EUSOMA) database that contains data collected by EU breast centers, that in the relevant time period were part of the EUSOMA Network. We identified all females with a new breast cancer diagnosed in the period 2010 to 2019 in the EUSOMA database. The analysis was conducted on anonymous and cumulative data. The data were registered by 58 EU breast centers, all of which entered at least 500 new diagnoses in the database in the ten-year period. Geographically, the contributing centers are located in Northern (Belgium, the Netherlands, Sweden), Central (Austria, France, Germany, Switzerland) and Southern (Italy, Portugal) EU. The use of ET by tumor behavior was studied in operated endocrine sensitive breast cancer. Trends were evaluated by age group (<50y, 50-69y, ≥70y) and geographical region (North, Central, South). A total of 77,835 operated patients with endocrine sensitive breast cancer was included, 72,749 IBC and 5,086 BCIS. In IBC, adjuvant ET was systematically given (94%) and in all age groups at least in 90%. Geographically, proportions were slightly higher in Southern EU breast centers (97%) compared to both Northern and Central EU (91%). In BCIS, 46% of endocrine sensitive patients received adjuvant ET. In patients older than 70 less adjuvant ET was used (38%) compared with the younger patients. Geographically, the same gradient as for IBC was observed: higher proportions in Southern EU breast centers (52%) compared to both Northern and Central EU (40%). The study of the real-world use of adjuvant ET in BCIS revealed a remarkably high percentage. Geographical study between EU centers and regions demonstrated different practices. QI making use of real-world EU data can help to monitor, evaluate, and eventually guide and align good clinical practice in the management of BC.

Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. Methods: The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. Results: On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. Conclusions: From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

The authors regret that Prof. Curigliano's affiliations were not correct in the original version. The authors would like to apologise for any inconvenience caused. About the French prohibition of textured breast implants: is it justified or over-cautious? The EUSOMA, ESSO/BRESSO positionThe BreastVol. 46PreviewAfter the publication of the EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants in January 2019 [1], the medical devices regulatory authority in France, the ANSM (National Agency of Medicine and Health Products), has recently banned all use of textured surface breast implants. This decision was based on concerns about the risk of BIA ALCL which may be more likely in women with textured versus smooth surfaced implants [2]. Full-Text PDF

Background: At present there is a lack of standardization of training in breast cancer surgery across Europe. The aim of this survey was to assess current practice in Europe regarding training in breast cancer (BC) surgery. Material and methods: General surgeons, surgical oncologists, gynecologist, and plastic surgeons in Europe were invited to participate in this bespoke survey including 19 questions. Results: The survey was sent to 3.000 surgical oncologists across Europe. A total of 671 physicians (387 general surgeons, 152 gynecologists, 126 surgical oncologist, 31 plastic surgeons) answered the survey (23% response rate). Four hundred and sixty-eight physicians devoted between 50%-100% of their job to treating breast cancer. 45% worked in a community/University hospital within a dedicated Breast Unit. Specific additional breast surgery training was not universal: 20% had undertaken an accredited breast fellowship, 30% in a Breast Unit as a trainee, 21% had done additional courses, masters or diploma and 8% had not done any additional training. The majority (61%) of respondents worked in Units treating >150 BC cases per year, while 26% of the responders treat >120 new primary cases per year, and 23% less than 50 new cases a year. Multivariate analysis showed that breast surgeons working in a Breast Unit and treating more than 50 cases/year significantly performed oncoplastic procedures. Conclusion: There is a great variability in breast cancer surgery training in Europe. It is imperative to develop quality standards for breast cancer surgery training to ensure that patients get standardized and certified surgical management regardless of the country in which they are treated. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

During the last two decades the number of breast implants used in aesthetic, oncologic and risk reducing surgery has increased substantially mainly due to the improvement and confirmed safety of these devices. Since identification of the first case of anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) 20 years ago, there has been an increase in the number of reports of this very rare disease, demonstrating a clear association with breast implants. Whilst the majority of cases are localised and cured by implant removal and full capsulectomy, a small percentage require chemotherapy and the mortality rate is very low. The evidence linking BIA-ALCL to implant surface texturing, as the majority of cases were diagnosed in patients with textured implants, has raised concerns about the long term safety of these devices resulting in patient and regulatory authority concerns globally. We hereby present the current published knowledge about the link between BIA-ALCL and implant surface texture and a review of current regulatory and professional body advice across Europe, which may enable a better understanding of this rare disease, how to manage and ultimately prevent it. We conclude by giving EUSOMA recommendation, towards the unnecessary change in attitudes towards implant based surgery, according to the most recent available published evidence as long as patients are properly informed about the risk of BIA-ALCL.

After the publication of the EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants in January 2019 [ [1] Cardoso M.J. Wyld L. Rubio I.T. Leidenius M. Curigliano G. Cutuli B. et al. EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants. Breast. 2019; 44: 90-93 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar ], the medical devices regulatory authority in France, the ANSM (National Agency of Medicine and Health Products), has recently banned all use of textured surface breast implants. This decision was based on concerns about the risk of BIA ALCL which may be more likely in women with textured versus smooth surfaced implants [ [2] ANSM Portant interdiction de mise sur le marché, de distribution, de publicité et d'utilisation d'implants mammaires à enveloppe macro-texturée et d'implants mammaires polyuréthane, ainsi que retrait de ces produits. 2019www.ansm.sante.fr Google Scholar ]. Corrigendum to "About the French prohibition of textured breast implants: Is it justified or over-cautious? The EUSOMA, ESSO/BRESSO position" [Breast 46 (August 2019) 95–96]The BreastVol. 48PreviewThe authors regret that Prof. Curigliano's affiliations were not correct in the original version. Full-Text PDF Open Access

The authors regret that Prof. Curigliano's affiliations were not correct in the original version. The authors would like to apologise for any inconvenience caused. EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implantsThe BreastVol. 44PreviewDuring the last two decades the number of breast implants used in aesthetic, oncologic and risk reducing surgery has increased substantially mainly due to the improvement and confirmed safety of these devices. Since identification of the first case of anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) 20 years ago, there has been an increase in the number of reports of this very rare disease, demonstrating a clear association with breast implants. Whilst the majority of cases are localised and cured by implant removal and full capsulectomy, a small percentage require chemotherapy and the mortality rate is very low. Full-Text PDF

AIM OF THE STUDY:The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast centres to establish minimum standards and ensure specialist multidisciplinary care. Prospectively collected anonymous information on primary breast cancer cases diagnosed and treated in the units is transferred annually to a central EUSOMA data warehouse for continuous monitoring of quality indicators (QIs) to improve quality of care. Units have to comply with the EUSOMA Breast Centre guidelines and are audited by peers. The database was started in 2006 and includes over 110,000 cancers from breast centres located in Germany, Switzerland, Belgium, Austria, The Netherlands, Spain, Portugal and Italy. The aim of the present study is assessing time trends of QIs in EUSOMA-certified breast centres over the decade 2006-2015. MATERIALS AND METHODS:Previously defined QIs were calculated for 22 EUSOMA-certified breast centres (46122 patients) during 2006-2015. RESULTS:On the average of all units, the minimum standard of care was achieved in 8 of 13 main EUSOMA QIs in 2006 and in all in 2015. All QIs, except removal of at least 10 lymph nodes at axillary clearance and oestrogen receptor-negative tumours (T > 1 cm or N+) receiving adjuvant chemotherapy, improved significantly in this period. The desirable target was reached for two QIs in 2006 and for 7 of 13 QIs in 2015. CONCLUSION:The EUSOMA model of audit and monitoring QIs functions well in different European health systems and results in better performance of QIs over the last decade. QIs should be evaluated and adapted on a regular basis, as guidelines change over time.

AIM OF THE STUDY:The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast units to establish minimum standards and ensure specialist multidisciplinary care. In the present study we assess the impact of EUSOMA certification for all breast units for which sufficient information was available before and after certification.MATERIALS AND METHODS:For 22 EUSOMA certified breast units data of 30,444 patients could be extracted from the EUSOMA database on the evolution of QI's before and after certification.RESULTS:On the average of all units, the minimum standard of care was achieved for 12/13 QI's before and after EUSOMA certification (not met for DCIS receiving just one operation). There was a significant improvement of 5 QI's after certification. The proportion of patients with invasive cancer undergoing an axillary clearance containing >9 lymph nodes (91.5% vs 89.4%, p 0.003) and patients with invasive cancer having just 1 operation (83.1% vs 80.4%, p < 0.001) dropped, but remained above the minimum standard. The targeted standard of breast care was reached for the same 4/13 QI's before and after EUSOMA certification.CONCLUSION:Although the absolute effect of EUSOMA certification was modest it further increases standards of care and should be regarded as part of a process aiming for excellence. Dedicated units already provide a high level of care before certification, but continuous monitoring and audit remains of paramount importance as complete adherence to guidelines is difficult to achieve.