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ANTHEM Feasibility Study
Breast conserving surgery (BCS) with radiotherapy is the preferred treatment for the large majority of women with breast cancer. However, mastectomy with or without (+/-) immediate breast reconstruction (IBR) is often recommended to avoid poor cosmetic outcomes often associated with standard BCS techniques. Currently 40% of the 55,000 UK women diagnosed with breast cancer each year undergo mastectomy of whom 1 in 4 have reconstruction. Oncoplastic breast conserving surgery (OPBCS) describes a range of volume replacement (e.g. local perforator flaps) and volume displacement techniques (e.g. therapeutic mammaplasty) that combine removing the cancer with plastic surgical and aesthetic techniques. These newer techniques can extend the role of BCS and may allow some women to avoid mastectomy. High-quality research to determine whether OPBCS offers a safe and effective alternative to mastectomy +/- IBR is currently lacking. Preliminary work is needed to ensure a future large-scale study is feasible, well-designed and addresses questions important to patients and the NHS.
Mixed methods will be used to inform feasibility and design of a future large-scale study comparing the clinical and cost-effectiveness of OPBCS and mastectomy +/- IBR. It will have four parts:
1. A national practice questionnaire to determine current practice and provision of oncoplastic breast and reconstructive surgery in the UK
2. A pilot multicentre prospective cohort study to explore the proportion of patients choosing OPBCS vs. mastectomy; the proportion in whom OPBCS is successful and clinical and patient-reported outcomes of different techniques at 3 and 12-months post-surgery.
3. A qualitative interview study to explore patients’ attitudes to different procedures; rationale for decision-making and perceptions of outcomes. .
4. Design of the future study
All centres offering OPBCS and mastectomy in the UK will be invited to participate. Recruitment is planned to commence winter 2020 and continue for 12 months.
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