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178. Breast cancer: Analysis of the first 1000 sentinel lymph node dissections at The Royal Alexandra Hospital
ABSTRACTS Conclusion: A low vitamin D can cause bone pain. We feel this shows a high proportion of breast cancer patients have vitamin D insufficiency. (79.6% Vs 37.5% healthy controls) We feel this should be tested routinely for patients with bone pain prior to expensive bone scan during follow up. However in our small cohort 25% of patients with low Vitamin D also had bone metastases these results do not support omission of bone scan in patients with Vitamin D insufficiency and history of breast cancer. However patients with low levels of vitamin D should be treated to improve their symptoms and reduce anxiety about metastatic disease. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.172
178. Breast cancer: Analysis of the first 1000 sentinel lymph node dissections at The Royal Alexandra Hospital E.C. Wright1, K. Krupa1, A. Al-Hasso2, L. Anderson1, M. McKirdy1 1 Royal Alexandra Hospital Paisley, General Surgery, Glasgow, United Kingdom 2 The Beatson West of Scotland Cancer Centre, Oncology, Glasgow, United Kingdom Background: The status of the axillary lymph nodes is a key determinant of prognosis and further treatment in early breast cancer. Traditionally the axilla was cleared by axillary lymph node dissection (ALND). This operation is associated with significant post-operative morbidity. More recently sentinel lymph node dissection (SLND), which is associated with less morbidity, has been found to be a safe alternative for axillary staging in those with clinically negative axillas. In our institution, despite not having a nuclear medicine department, SLND began in 2007. Upon completion of the first 1000 cases we sought to audit our performance against standards reported in the literature. Methods: The first 1000 SLNDs were identified via a prospectively maintained database. There were no exclusion criteria, patients with both palpable and impalpable tumours and patients who had previously had surgery were included. The database recorded: date of injection of radioactive colloid, date of surgery, the responsible surgeon and whether or not a SLN was successfully identified.. Results: The SLN was successfully identified in 95.1% of cases. Most cases were injected with radioactive colloid on the same day as surgery (55.9%) with 97.7% having a SLN identified. This was significantly better than the group injected the day prior to theatre where only 91.8% had a SLN identified (P<0.05). There were 49 unsuccessful procedures. Of these, 3 were attributed to a ’technical fault’, previous axillary surgery was cited as a factor in 3 cases, 1 case had an extensive tumour found in the axilla but in 85.7% (42 cases) no reason was recorded. Most unsuccessful procedures (73.5%, n¼36) were in patients injected on the day prior to theatre. Following further surgery 28 (57.1%) of the axillas where there had been an unsuccessful SLND were found to be negative. One surgeon (surgeon A) was responsible for the majority of SLNDs (54.7%). Surgeons B and C were responsible for 29.9% and 15.4% of cases respectively. All 3 surgeons identified the SLN in >90% of cases. Conclusions: Our overall 95.1% success rate is comparable to rates quoted in most published series. Our experience demonstrates that SLND can be successfully introduced to institutions with no nuclear medicine facilities, that surgeons can be effectively trained using the ‘Newstart’ model and that there is a need to further study the effect of timing of isotope injection on the successful identification of sentinel nodes. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.173
S77 179. Mammographic screening in the 3-million population region of Lower Silesia, Poland: Cost of cancer detection during initial and subsequent round R. Matkowski1, P. Kasprzak2, M. Jagas2, M. Zietek2, D. Blaszczyk2, J. Kotowska2, B. Szynglarewicz2 1 Wroclaw Medical University, Department of Oncology and Division of Surgical Oncology, Wroclaw, Poland 2 Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw, Poland Background: Potential benefit of nation-wide population-based breast cancer screening programme needs to balanced against the financial burden for the health care system. The aim of this study was to assess the cost of cancer detection in the initial and subsequent screening round. Material and methods: Population-based nation-wide breast cancer screening programme targets women aged 50-69 without breast cancer history. Biennial two-view screen-film mammography is used as a standard screening test. Data for this study were prospectively collected using the SIMP- official electronic system for monitoring of prophylaxis programmes, as well as the databases of the regional branch of National Health Fund and the Lower Silesian Cancer Registry. The amount of expenses was obtained from the Regional Coordinating Centre for Screening Programmes. The number of screen-detected and pathologically proven cancers (both invasive and ductal in situ) was calculated. Costs of cancer detection were measured and converted into US dollars and Euros (USD/EU) using official tables of the Polish National Bank. Results: The total expense for the programme in the region of Lower Silesia during the initial (2007-2008) and the subsequent (2009-2010) round was 4,214,811 USD / 3,087,680 EU and 5,412,613 USD/ 3,962,344 EU, respectively. The number of detected cancers was 1049 and 987. The average cost of breast cancer detection in the screening programme during 2007-2010 was 4730 USD / 3460 EU. The cost-effectiveness ratio obtained in initial and subsequent screening was respectively 4020 USD / 2940 EU and 5480 USD /4010 EU per cancer found. Conclusions: Comparison between costs and effects among different screening programmes is difficult. However, our programme looks not expensive when considering reports of mammographic screening at its start in Western Europe (Italy 1991-1992, Spain 1995-1996). Despite the onethird rising in the subsequent screening, cost of breast cancer detection remains low during both rounds making the programme applicable for middle-income country. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.174
180. Quality of initial and subsequent breast cancer screening in the 3million population region of Lower Silesia (Poland) R. Matkowski1, P. Kasprzak2, M. Jagas2, M. Zietek2, D. Blaszczyk2, J. Kotowska2, B. Szynglarewicz2 1 Wroclaw Medical University, Department of Oncology and Division of Surgical Oncology, Wroclaw, Poland 2 Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw, Poland Background: Population-based mammographic screening was widely introduced in Poland in 2007. Aim of this study was to assess the quality of programme and compare performance indicators between initial (20072008) and subsequent (2009-2010) screening. Material and methods: Programme covers 50-69 aged women without breast cancer history. The standard test is screen-film twoview (cranio-caudal and oblique) mammography performed every two years. Attendees are examined every two years. Quality evaluation
178. Breast cancer: Analysis of the first 1000 sentinel lymph node dissections at The Royal Alexandra Hospital E.C. Wright1, K. Krupa1, A. Al-Hasso2, L. Anderson1, M. McKirdy1 1 Royal Alexandra Hospital Paisley, General Surgery, Glasgow, United Kingdom 2 The Beatson West of Scotland Cancer Centre, Oncology, Glasgow, United Kingdom Background: The status of the axillary lymph nodes is a key determinant of prognosis and further treatment in early breast cancer. Traditionally the axilla was cleared by axillary lymph node dissection (ALND). This operation is associated with significant post-operative morbidity. More recently sentinel lymph node dissection (SLND), which is associated with less morbidity, has been found to be a safe alternative for axillary staging in those with clinically negative axillas. In our institution, despite not having a nuclear medicine department, SLND began in 2007. Upon completion of the first 1000 cases we sought to audit our performance against standards reported in the literature. Methods: The first 1000 SLNDs were identified via a prospectively maintained database. There were no exclusion criteria, patients with both palpable and impalpable tumours and patients who had previously had surgery were included. The database recorded: date of injection of radioactive colloid, date of surgery, the responsible surgeon and whether or not a SLN was successfully identified.. Results: The SLN was successfully identified in 95.1% of cases. Most cases were injected with radioactive colloid on the same day as surgery (55.9%) with 97.7% having a SLN identified. This was significantly better than the group injected the day prior to theatre where only 91.8% had a SLN identified (P<0.05). There were 49 unsuccessful procedures. Of these, 3 were attributed to a ’technical fault’, previous axillary surgery was cited as a factor in 3 cases, 1 case had an extensive tumour found in the axilla but in 85.7% (42 cases) no reason was recorded. Most unsuccessful procedures (73.5%, n¼36) were in patients injected on the day prior to theatre. Following further surgery 28 (57.1%) of the axillas where there had been an unsuccessful SLND were found to be negative. One surgeon (surgeon A) was responsible for the majority of SLNDs (54.7%). Surgeons B and C were responsible for 29.9% and 15.4% of cases respectively. All 3 surgeons identified the SLN in >90% of cases. Conclusions: Our overall 95.1% success rate is comparable to rates quoted in most published series. Our experience demonstrates that SLND can be successfully introduced to institutions with no nuclear medicine facilities, that surgeons can be effectively trained using the ‘Newstart’ model and that there is a need to further study the effect of timing of isotope injection on the successful identification of sentinel nodes. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.173
S77 179. Mammographic screening in the 3-million population region of Lower Silesia, Poland: Cost of cancer detection during initial and subsequent round R. Matkowski1, P. Kasprzak2, M. Jagas2, M. Zietek2, D. Blaszczyk2, J. Kotowska2, B. Szynglarewicz2 1 Wroclaw Medical University, Department of Oncology and Division of Surgical Oncology, Wroclaw, Poland 2 Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw, Poland Background: Potential benefit of nation-wide population-based breast cancer screening programme needs to balanced against the financial burden for the health care system. The aim of this study was to assess the cost of cancer detection in the initial and subsequent screening round. Material and methods: Population-based nation-wide breast cancer screening programme targets women aged 50-69 without breast cancer history. Biennial two-view screen-film mammography is used as a standard screening test. Data for this study were prospectively collected using the SIMP- official electronic system for monitoring of prophylaxis programmes, as well as the databases of the regional branch of National Health Fund and the Lower Silesian Cancer Registry. The amount of expenses was obtained from the Regional Coordinating Centre for Screening Programmes. The number of screen-detected and pathologically proven cancers (both invasive and ductal in situ) was calculated. Costs of cancer detection were measured and converted into US dollars and Euros (USD/EU) using official tables of the Polish National Bank. Results: The total expense for the programme in the region of Lower Silesia during the initial (2007-2008) and the subsequent (2009-2010) round was 4,214,811 USD / 3,087,680 EU and 5,412,613 USD/ 3,962,344 EU, respectively. The number of detected cancers was 1049 and 987. The average cost of breast cancer detection in the screening programme during 2007-2010 was 4730 USD / 3460 EU. The cost-effectiveness ratio obtained in initial and subsequent screening was respectively 4020 USD / 2940 EU and 5480 USD /4010 EU per cancer found. Conclusions: Comparison between costs and effects among different screening programmes is difficult. However, our programme looks not expensive when considering reports of mammographic screening at its start in Western Europe (Italy 1991-1992, Spain 1995-1996). Despite the onethird rising in the subsequent screening, cost of breast cancer detection remains low during both rounds making the programme applicable for middle-income country. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.174
180. Quality of initial and subsequent breast cancer screening in the 3million population region of Lower Silesia (Poland) R. Matkowski1, P. Kasprzak2, M. Jagas2, M. Zietek2, D. Blaszczyk2, J. Kotowska2, B. Szynglarewicz2 1 Wroclaw Medical University, Department of Oncology and Division of Surgical Oncology, Wroclaw, Poland 2 Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw, Poland Background: Population-based mammographic screening was widely introduced in Poland in 2007. Aim of this study was to assess the quality of programme and compare performance indicators between initial (20072008) and subsequent (2009-2010) screening. Material and methods: Programme covers 50-69 aged women without breast cancer history. The standard test is screen-film twoview (cranio-caudal and oblique) mammography performed every two years. Attendees are examined every two years. Quality evaluation