Past
The twenty-first century has modernized breast cancer surgery, transitioning from traditional breast conservation surgery and mastectomy procedures to incorporating reconstructive options. Reconstructive surgery has increased nearly 20% annually1. In part, this can be explained by novel breast conservation operations such as oncoplastic surgery that offers patients improved excellent oncologic and reconstructive quality of life2,3. Regardless of surgical approach, oncologic safety regulates the pre-operative informed decision making process where surgeons can educate patients and discuss complications associated with each intervention. Established predictors for post-complications non-specific to breast surgery include smoking, radiation, obesity, diabetes and increasing ASA classification4. Other unique patient risk factors such as demographics, comorbidities and surgical predictors offer improved predictability for to calculate a post-operative complication risk but there use was unquantifiable until now.
Present
In this study, we developed and validated (internally and externally) four predictive models that utilize breast cancer patient specific demographics (E.g. age, ethnicity, race), comorbidities (E.g. hypertension, COPD) and surgical factors (E.g. drain placement)5. Using these risk factors improved predictability and accuracy of the models. To illustrate our findings in a patient-friendly manner we constructed the Breast Cancer Surgery Risk Calculator (BCSRc). This validated breast surgery risk calculator is freely accessible at www.breastcalc.org. This online patient-centered, decision aid can calculate a patients individualized, complication risk for five surgical interventions: a partial mastectomy, oncoplastic surgery, mastectomy alone, mastectomy with implant or tissue expander reconstruction, and mastectomy with autologous tissue reconstruction. Another advantage of the BCSRc compared to previous breast surgery calculators is that it incorporates predictive outcomes for both breast conservation (including oncoplastic surgery) and mastectomy (with or without reconstruction) operations. This provides an additional, validated decision making tool that takes into consideration the pre-operative traits of the breast cancer patient and provides tailored complication rates for the 5 possible breast surgery options; thus, empowering the patient and surgical team in their shared decision making process.
Future
Our findings and validated online risk calculator enables surgeons to quantify a complication risk unique to a patient. This valuable contribution to the decision making process can help alleviate some stressors pre-operatively for both patients and surgeons. Future promotion for the adoption of such tools is important so that patients are better informed about surgical risks. In general, surgeon accountability is increasing with outcome measures such as post-operative complication rates and patient satisfaction scores making predictive risk calculators all the more important as tools in pre-operative counseling.
Acknowledgments
Conflicts of Interest and Disclosure of Funding: All authors report no conflicts of interest. The described study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, and Award Number TL1TR002546 and the American Cancer Society grant # CRP-17–112-06-COUN.
Footnotes
Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.
Disclosures: The authors declare no conflicts of interest.
References
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