Opportunities and priorities for breast surgical research

Abstract

Background: The Breast Cancer Campaign Gap analysis (2013) established breast cancer research priorities without specific focus on surgical research nor the role of surgeons. The majority of breast cancer patients encounter a surgeon at diagnosis or during treatment, thus surgical involvement in design and delivery of high-quality research to improve patient care is critical. This review aims to identify opportunities and priorities for breast surgical research to complement the previous gap analysis.

Methods: Research-active breast surgeons met and identified topic areas for breast surgical research which mapped to the patient pathway. These included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy and special groups (e.g. risk-reducing surgery). Section leads were identified based on research interests with invited input from experts in specific areas, supported by consultation with the Association of Breast Surgery (ABS) membership and Independent Cancer Patients’ Voice (ICPV). The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear.

Results: Key research gaps were identified for each topic area including: (1) issues surrounding overdiagnosis and treatment; (2) optimising selection for neoadjuvant therapies and subsequent surgery; (3) reducing re-operation rates for breast conserving surgery; (4) generating evidence for the clinical and cost-effectiveness of breast reconstruction and mechanisms for evaluating novel interventions; (5) determining optimal axillary management, especially post-neoadjuvant treatment; (6) defining and standardising indications for risk-reducing surgery. Strategies for resolving these knowledge gaps are proposed.

Conclusions: Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and the NHS. Development of infrastructure and surgical research capacity together with appropriate allocation of research funding will be needed to successfully address the key clinical and translational research gaps highlighted in this analysis within the next two decades.

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