Çakmak Güldeniz Karadeniz, Emiroğlu Selman, Sezer Atakan, Canturk Nuh Zafer, Yeniay Levent, Kuru Bekir, Karanlık Hasan, Soyder Aykut, Gökgöz Şehsuvar, Sakman Gürhan, Ucuncu Muhammed, Akcay Mufide Nuran, Girgin Sadullah, Gurdal Sibel Ozkan, Emiroglu Mustafa, Ozbas Serdar, Öz Abdullah Bahadir, Arici Cumhur, Toktas Osman, Demircan Orhan, Çalık Adnan, Polat Ayfer Kamali, Maralcan Gokturk, Demirer Seher, Ozmen Vahit
Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
JCO Glob Oncol. 2020 Feb;6:285-292. doi: 10.1200/JGO.19.00275.
Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018.
Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients' choices, surgical approaches, and academic institutions.
All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia ( < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery.
Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.
乳腺癌是女性中最常见的癌症，不同国家在治疗该癌症的手术实践方面存在很大差异。本研究的目的是分析土耳其乳腺疾病协会联合会的指南对设有乳腺中心的学术机构的影响，并评估2018年土耳其的手术实践情况。
2019年1月至3月期间，向在学术机构乳腺中心工作的乳腺外科医生发送了一份调查问卷。抽样框架包括土耳其18个城市的24个设有乳腺中心的学术机构，以评估乳腺中心之间以及土耳其七个地区在患者选择、手术方法和学术机构方面的跨学科差异。
所有外科医生都对调查做出了回应，共纳入了4381名患者。大多数外科医生（73.9%）在乳腺中心工作。87%的乳腺中心开展了多学科肿瘤委员会会议。临床评估与开始治疗之间的平均时间为29天；最长时间在东安纳托利亚东南部（66天）。仅6%的患者患有导管原位癌。全国每个地区都可进行前哨淋巴结活检，64.5%的患者接受了该检查。2018年，土耳其的总体保乳手术率为57.3%，从黑海地区的72.2%到安纳托利亚中部的33.5%不等（P<0.001）。所有乳腺中心都提供肿瘤整形乳房手术选项。然而，黑海地区25%的乳腺中心以及东安纳托利亚和地中海地区一半的乳腺中心未开展此类手术。
不可触及乳腺癌发病率的上升和局部区域复发率的下降有利于保乳手术，尤其是在发达国家。土耳其乳腺疾病协会联合会的指南促使土耳其出现了更全面的乳腺中心，并改善了乳腺健康状况。
