Analysis of Surgical Procedures for Breast Cancer in Pakistan Institute of Medical Sciences: A Decade of Change

Objective: To assess the changing practices of surgical procedures for Breast Cancer over the last decade in a tertiary care general surgical department Pakistan Institute of Medical Sciences (PIMS), Islamabad. Study Design: Retrospective Comparative Study Place and Duration of the Study: Records of Breast cancer patients, who were operated in main operation theatre of PIMS Islamabad in 1999/2000 and 2009/2010 Materials and Methods: Records of Breast cancer patients, who were operated in main operation theatre of PIMS Islamabad in 1999/2000 and 2009/2010, were studied retrospectively. Comparative analysis of different primary surgical procedures was undertaken and measured against the international surgical oncology guidelines for the surgical management of breast cancer. Results: 418 patients’ records were analyzed. Over the last decade we observed a dramatic increase in incidence of surgical procedures for breast cancer (about two-fold increase), a move to less invasive surgical techniques like breast conserving surgery, as well as increased number of down-staged breast cancer patients. A completely changed pattern of primary surgical approach from lumpectomy followed by mastectomy to mastectomy or breast conserving surgery after neoadjuvant therapy was noticed. We also witnessed the introduction of immediate breast reconstruction as part of routine practice. Conclusion: It is demonstrated that radical changes have occurred in the management of breast cancer in the last decade, in keeping with international guidelines. There is a need to continue to adapt our practice in light of emerging knowledge and best evidence.