tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2021-11-1-9-19tumors-810Research ArticleСОБСТВЕННЫЕ ИССЛЕДОВАНИЯ. ВОПРОСЫ ОНКОХИРУРГИИOWN RESEARCH. ONCOSURGERY ISSUESАнализ объема хирургического лечения рака молочной железы в странах с низким ассоциированным индексом «смертность/заболеваемость» (обзор)Analysis of the scope of surgical breast cancer treatment in countries with the low associated mortality-to-incidence ratio (review)АндреевД. А.AndreevD.  A.

Дмитрий А. Андреев, ученая степень «doctor», присужденная в Erasmus University Medical Center (Нидерланды), ведущий научный сотрудник научно-клинического отдела 

Москва

Dmitry A. Andreev, М. D., Ph. D., Leading Research Fellow, Scientific-Clinical Department

Moscow

AndreevDA@zdrav.mos.ruКашурниковА. Ю.KashurnikovA.  Yu.

Асан Ю. Кашурников, кандидат медицинских наук, врач-онколог, ведущий специалист, отдел методологии и эффективности деятельности учреждений здравоохранения по профилю онкология/сектор по реализации национальных проектов

Москва

Asan Yu. Kashurnikov, M. D., Ph. D., Leading Specialist, Department of Methodology and Efficiency of Health Care Institutions in the Field of Oncology / Sector for the Implementation of National Projects 

Moscow

sic4@ya.ruЗавьяловА. А.ZavyalovA.  A.

Александр А. Завьялов, доктор медицинских наук, профессор; врач-онколог, заведующий научно-клиническим отделом

Москва

Aleksander A. Zavyalov, М. D., Ph. D., DSc, Professor of Oncology, Head of the Scientific — Clinical Department 

Moscow

ZavyalovAA3@zdrav.mos.ruГосударственное бюджетное учреждение города Москвы «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»РоссияThe State Budgetary Institution «Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department»Russian Federation202128042021111919Copyright © Андреев Д.А., Кашурников А.Ю., Завьялов А.А., 20212021Андреев Д.А., Кашурников А.Ю., Завьялов А.А.Andreev D.A., Kashurnikov A.Y., Zavyalov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/810

Широкое внедрение «прорывных» хирургических подходов с сохранением органа, развитие маммопластических методик, а также новой техники выполнения биопсии сигнальных лимфатических узлов, обеспечило переход на новый уровень качества оказания онкологической помощи при раке молочной железы (РМЖ). Целью обзора является обобщение актуальных сведений об аудитах современных методов хирургического лечения РМЖ на примере стран с высокой заболеваемостью и относительно низкой ассоциированной смертностью. 

The worldwide implementation of «breakthrough» surgical approaches such as breast-conserving techniques, the development of mammoplasty, as well as new guidelines for performing biopsy of sentinel lymph nodes incentivized the transition to a higher level of quality in breast cancer care. This review summarizes the modern tendencies in audits of main breast cancer surgical treatments based on last experience of few countries demonstrating the low breast cancer mortality and high incidence (lowest breast cancer mortality-to-incidence ratio).

аудитхирургическая техникарак молочной железыauditquality indicatorsbreast cancersurgeryReferencesVerhoeven D, Allemani C, Kaufman C, Mansel R, Siesling S, Anderson B. Breast Cancer: global quality care optimizing care delivery with existing financial and personnel resources. ESMO open. 2020;4 (Suppl 2):e000 861.Verhoeven D, Allemani C, Kaufman C, Mansel R, Siesling S, Anderson B. Breast Cancer: global quality care optimizing care delivery with existing financial and personnel resources. ESMO open. 2020;4 (Suppl 2):e000 861.Malycha P, Tyson S. National breast surgery audit. Aust N Z J Surg [Internet]. 2000 Dec 5;70 (12):834–6. Available from: http://doi.wiley.com/10.1046/j.1440–1622.2000.02002.xMalycha P, Tyson S. National breast surgery audit. Aust N Z J Surg [Internet]. 2000 Dec 5;70 (12):834–6. Available from: http://doi.wiley.com/10.1046/j.1440–1622.2000.02002.xMarinkovic M, Djordjevic N, Djordjevic L, Ignjatovic N, Djordjevic M, Karanikolic V. Assessment of the quality of life in breast cancer depending on the surgical treatment [published online ahead of print]. Support Care Cancer [Internet]. 2020 Oct 24; Available from: http://www.ncbi.nlm.nih.gov/pubmed/33099655Marinkovic M, Djordjevic N, Djordjevic L, Ignjatovic N, Djordjevic M, Karanikolic V. Assessment of the quality of life in breast cancer depending on the surgical treatment [published online ahead of print]. Support Care Cancer [Internet]. 2020 Oct 24; Available from: http://www.ncbi.nlm.nih.gov/pubmed/33099655Nasser JS, Chung WHJ, Gudal RA, Kotsis S V, Momoh AO, Chung KC. Quality Measures in Postmastectomy Breast Reconstruction: Identifying Metrics to Improve Care. Plast Reconstr surgery Glob open. 2020 Feb;8 (2):e2630.Nasser JS, Chung WHJ, Gudal RA, Kotsis S V, Momoh AO, Chung KC. Quality Measures in Postmastectomy Breast Reconstruction: Identifying Metrics to Improve Care. Plast Reconstr surgery Glob open. 2020 Feb;8 (2):e2630.van Bommel ACM, Spronk PER, Vrancken Peeters M-JTFD, Jager A, Lobbes M, Maduro JH, Mureau MAM, Schreuder K, Smorenburg CH, Verloop J, Westenend PJ, Wouters MWJM, Siesling S, Tjan-Heijnen VCG, van Dalen T. Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit. J Surg Oncol. 2017 Mar;115 (3):243–9.van Bommel ACM, Spronk PER, Vrancken Peeters M-JTFD, Jager A, Lobbes M, Maduro JH, Mureau MAM, Schreuder K, Smorenburg CH, Verloop J, Westenend PJ, Wouters MWJM, Siesling S, Tjan-Heijnen VCG, van Dalen T. Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit. J Surg Oncol. 2017 Mar;115 (3):243–9.Spronk PER, Volders JH, van den Tol P, Smorenburg CH, Vrancken Peeters M-JTFD. Breast conserving therapy after neoadjuvant chemotherapy; data from the Dutch Breast Cancer Audit. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2019 Feb;45 (2):110–7.Spronk PER, Volders JH, van den Tol P, Smorenburg CH, Vrancken Peeters M-JTFD. Breast conserving therapy after neoadjuvant chemotherapy; data from the Dutch Breast Cancer Audit. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2019 Feb;45 (2):110–7.Cuncins-Hearn A V, Boult M, Babidge W, Zorbas H, Villanueva E, Evans A, Oliver D, Kollias J, Reeve T, Maddern G. National breast cancer audit: overview of invasive breast cancer management. ANZ J Surg. 2006 Aug;76 (8):745–50.Cuncins-Hearn A V, Boult M, Babidge W, Zorbas H, Villanueva E, Evans A, Oliver D, Kollias J, Reeve T, Maddern G. National breast cancer audit: overview of invasive breast cancer management. ANZ J Surg. 2006 Aug;76 (8):745–50.Jeevan R, Cromwell DA, Browne JP, Caddy CM, Pereira J, Sheppard C, Greenaway K, van der Meulen JHP. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg [Internet]. 2014 Oct;67 (10):1333–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24908545Jeevan R, Cromwell DA, Browne JP, Caddy CM, Pereira J, Sheppard C, Greenaway K, van der Meulen JHP. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg [Internet]. 2014 Oct;67 (10):1333–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24908545Wang C, Li X, Su S, Wang X, Li J, Bao X, Liu M. Factors analysis on the use of key quality indicators for narrowing the gap of quality of care of breast cancer. BMC Cancer. 2019 Nov;19 (1):1099.Wang C, Li X, Su S, Wang X, Li J, Bao X, Liu M. Factors analysis on the use of key quality indicators for narrowing the gap of quality of care of breast cancer. BMC Cancer. 2019 Nov;19 (1):1099.Eijkelboom A, Luyendijk M, Maaren M van, Munck L de, Schreuder K, Siesling S, Verloop J. © IKNL, oktober 2020. Borstkanker in Nederland trends 1989–2019 gebaseerd op cijfers uit de Nederlandse Kankerregistratie [Internet]. 2020. Available from: https://borstkanker.nl/sites/default/files/2020–10/RapportBorstkankerinNederland.pdfEijkelboom A, Luyendijk M, Maaren M van, Munck L de, Schreuder K, Siesling S, Verloop J. © IKNL, oktober 2020. Borstkanker in Nederland trends 1989–2019 gebaseerd op cijfers uit de Nederlandse Kankerregistratie [Internet]. 2020. Available from: https://borstkanker.nl/sites/default/files/2020–10/RapportBorstkankerinNederland.pdfЗолотой стандарт диагностики и лечения рака молочной железы. Российское общество онкомаммологов. Версия 1.0 [Internet]. 2020 [cited 2021 Feb 10]. Available from: http://www.abvpress.ru/project/www.abvpress.ru/KR_ROOM_2020.pdfЗолотой стандарт диагностики и лечения рака молочной железы. Российское общество онкомаммологов. Версия 1.0 [Internet]. 2020 [cited 2021 Feb 10]. Available from: http://www.abvpress.ru/project/www.abvpress.ru/KR_ROOM_2020.pdfStordeur S, Vrijens F, Beirens K, Vlayen J, Devriese S, Van Eycken E. Kwaliteitsindicatoren in oncologie: borstkanker. Good Clinical Practice (GCP). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2010. KCE Reports 150A. D2010 / 10.273 / 99 [Internet]. [cited 2021 Feb 10]. Available from: https://kce.fgov.be/sites/default/files/atoms/files/kce_150a_borstkanker.pdfStordeur S, Vrijens F, Beirens K, Vlayen J, Devriese S, Van Eycken E. Kwaliteitsindicatoren in oncologie: borstkanker. Good Clinical Practice (GCP). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2010. KCE Reports 150A. D2010 / 10.273 / 99 [Internet]. [cited 2021 Feb 10]. Available from: https://kce.fgov.be/sites/default/files/atoms/files/kce_150a_borstkanker.pdfWeber WP, Morrow M, Boniface J de, Pusic A, Montagna G, Kappos EA, Ritter M, Haug M, Kurzeder C, Saccilotto R, Schulz A, Benson J, Fitzal F, Matrai Z, Shaw J, Peeters M-JV, Potter S, Heil J. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol. 2020 Aug;21 (8):e375–85.Weber WP, Morrow M, Boniface J de, Pusic A, Montagna G, Kappos EA, Ritter M, Haug M, Kurzeder C, Saccilotto R, Schulz A, Benson J, Fitzal F, Matrai Z, Shaw J, Peeters M-JV, Potter S, Heil J. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol. 2020 Aug;21 (8):e375–85.Kaufman CS. Increasing Role of Oncoplastic Surgery for Breast Cancer. Curr Oncol Rep. 2019;21 (12):111.Kaufman CS. Increasing Role of Oncoplastic Surgery for Breast Cancer. Curr Oncol Rep. 2019;21 (12):111.Urban C, Anselmi KF, Kuroda F, Schwartz JC. Oncoplasty as the standard of care in breast cancer surgery. Eur Oncol Haematol. 2014;10 (1):43–7.Urban C, Anselmi KF, Kuroda F, Schwartz JC. Oncoplasty as the standard of care in breast cancer surgery. Eur Oncol Haematol. 2014;10 (1):43–7.Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet (London, England). 2021 Jan;397 (10 272):387–97.Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet (London, England). 2021 Jan;397 (10 272):387–97.NHS., MRC. GlobalSurg 3. Качество и результаты глобальной онкохирургии: проспективное, международное когортное исследование [Internet]. 2018 [cited 2021 Feb 11]. Available from: https://canceratlas.cancer.org/the-burden/breastcancer/NHS., MRC. GlobalSurg 3. Качество и результаты глобальной онкохирургии: проспективное, международное когортное исследование [Internet]. 2018 [cited 2021 Feb 11]. Available from: https://canceratlas.cancer.org/the-burden/breastcancer/Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240 (2):205–13.Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240 (2):205–13.World Health Organization. International Agency for Research on Cancer. The Global Cancer Observatory [Internet]. 2021 [cited 2021 Feb 11]. Available from: https://gco.iarc.fr/World Health Organization. International Agency for Research on Cancer. The Global Cancer Observatory [Internet]. 2021 [cited 2021 Feb 11]. Available from: https://gco.iarc.fr/Kang SY, Kim YS, Kim Z, Kim HY, Kim HJ, Park S, Bae SY, Yoon KH, Lee SB, Lee SK, Jung K-W, Han J, Youn HJ. Breast Cancer Statistics in Korea in 2017: Data from a Breast Cancer Registry. J Breast Cancer. 2020 Apr;23 (2):115–28.Kang SY, Kim YS, Kim Z, Kim HY, Kim HJ, Park S, Bae SY, Yoon KH, Lee SB, Lee SK, Jung K-W, Han J, Youn HJ. Breast Cancer Statistics in Korea in 2017: Data from a Breast Cancer Registry. J Breast Cancer. 2020 Apr;23 (2):115–28.National Breast Cancer Audit Reports| National Screening Unit [Internet]. [cited 2021 Feb 8]. Available from: https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/publications-and-reports/national-breast-cancer-auditNational Breast Cancer Audit Reports| National Screening Unit [Internet]. [cited 2021 Feb 8]. Available from: https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/publications-and-reports/national-breast-cancer-auditThe Royal Australasian College of Surgeons (RACS). BreastSurgANZ Quality Audit. Annual Report 2018. [Internet]. 2020 [cited 2021 Feb 25]. Available from: https://www.surgeons.org/The Royal Australasian College of Surgeons (RACS). BreastSurgANZ Quality Audit. Annual Report 2018. [Internet]. 2020 [cited 2021 Feb 25]. Available from: https://www.surgeons.org/Salindera S, Ogilvy M, Spillane A. What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand? Breast. 2020 Jun;51:94–101.Salindera S, Ogilvy M, Spillane A. What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand? Breast. 2020 Jun;51:94–101.Wouter Beke, Vlaams minister van Welzijn, Volksgezondheid en Gezin. Jaarrapport 2020 Bevolkingsonderzoek [Internet]. [cited 2021 Feb 9]. Available from: https://borstkanker.bevolkingsonderzoek.be/sites/default/files/atoms/files/Jaarrapport2020.pdfWouter Beke, Vlaams minister van Welzijn, Volksgezondheid en Gezin. Jaarrapport 2020 Bevolkingsonderzoek [Internet]. [cited 2021 Feb 9]. Available from: https://borstkanker.bevolkingsonderzoek.be/sites/default/files/atoms/files/Jaarrapport2020.pdfVlayen J, Stordeur S, Vrijens F, Van EyckenE. Kwaliteitsindicatoren in oncologie: voorwaarden voor het opzetten van een kwaliteitssysteem. Good Clinical Practice (GCP). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2011. KCE Reports 152A. [Internet]. [cited 2021 Mar 1]. Available from: https://kce.fgov.be/en/quality-indicators-inoncology-prerequisites-for-the-set—up-of-a-quality-systemVlayen J, Stordeur S, Vrijens F, Van EyckenE. Kwaliteitsindicatoren in oncologie: voorwaarden voor het opzetten van een kwaliteitssysteem. Good Clinical Practice (GCP). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2011. KCE Reports 152A. [Internet]. [cited 2021 Mar 1]. Available from: https://kce.fgov.be/en/quality-indicators-inoncology-prerequisites-for-the-set—up-of-a-quality-systemvan Dam PA, Tomatis M, Marotti L, Heil J, Mansel RE, Rosselli Del Turco M, van Dam PJ, Casella D, Bassani LG, Danei M, Denk A, Egle D, Emons G, Friedrichs K, Harbeck N, Kiechle M, Kimmig R, Koehler U, Kuemmel S, Maass N, Mayr C, Prové A, Rageth C, Regolo L, Lorenz-Salehi F, Sarlos D, Singer C, Sohn C, Staelens G, Tinterri C, Audisio R, Ponti A. Time trends (2006 - 2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer. 2017 Nov;85:15–22.van Dam PA, Tomatis M, Marotti L, Heil J, Mansel RE, Rosselli Del Turco M, van Dam PJ, Casella D, Bassani LG, Danei M, Denk A, Egle D, Emons G, Friedrichs K, Harbeck N, Kiechle M, Kimmig R, Koehler U, Kuemmel S, Maass N, Mayr C, Prové A, Rageth C, Regolo L, Lorenz-Salehi F, Sarlos D, Singer C, Sohn C, Staelens G, Tinterri C, Audisio R, Ponti A. Time trends (2006 - 2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer. 2017 Nov;85:15–22.Borstsparende chirurgie — indicator B6 | UZ Leuven [Internet]. [cited 2021 Feb 9]. Available from: https://www.uzleuven.be/nl/borstkanker/kwaliteitsindicatoren-borstkanker/borstsparende-chirurgie-indicator-b6Borstsparende chirurgie — indicator B6 | UZ Leuven [Internet]. [cited 2021 Feb 9]. Available from: https://www.uzleuven.be/nl/borstkanker/kwaliteitsindicatoren-borstkanker/borstsparende-chirurgie-indicator-b6Consensus Guideline on Breast Surgeon Quality Measurement [Internet]. 2018 [cited 2021 Feb 11]. Available from: https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Breast-Surgeon-Quality-Measurement.pdfConsensus Guideline on Breast Surgeon Quality Measurement [Internet]. 2018 [cited 2021 Feb 11]. Available from: https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Breast-Surgeon-Quality-Measurement.pdfLandercasper J, Bailey L, Buras R, Clifford E, Degnim AC, Thanasoulis L, Fayanju OM, Tjoe JA, Rao R. The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters. Ann Surg Oncol. 2017 Oct;24 (10):3093–106.Landercasper J, Bailey L, Buras R, Clifford E, Degnim AC, Thanasoulis L, Fayanju OM, Tjoe JA, Rao R. The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters. Ann Surg Oncol. 2017 Oct;24 (10):3093–106.The American Society of Breast Surgeons. Mastery of Breast SurgerySM [Internet]. [cited 2021 Feb 11]. Available from: https://masterybreastsurgeons.org/The American Society of Breast Surgeons. Mastery of Breast SurgerySM [Internet]. [cited 2021 Feb 11]. Available from: https://masterybreastsurgeons.org/Rijksinstituut voor Volksgezondheid en Milieu (RIVM). Uitvoeringskader bevolkingsonderzoek borstkanker [Internet]. 2020 [cited 2021 Feb 9]. Available from: https://www.rivm.nl/documenten/uitvoeringskader-bevolkingsonderzoekborstkankerRijksinstituut voor Volksgezondheid en Milieu (RIVM). Uitvoeringskader bevolkingsonderzoek borstkanker [Internet]. 2020 [cited 2021 Feb 9]. Available from: https://www.rivm.nl/documenten/uitvoeringskader-bevolkingsonderzoekborstkankerCopyright © 2019 Stichting DICA. Alle rechten voorbehouden. NABON breast cancer audit (NBCA) jaarverslag uitkomsten 2019. 16 oktober 2020 [Internet]. [cited 2021 Feb 9]. Available from: https://dica.nl/media/2511/NBCAJaarverslag2019.pdfCopyright © 2019 Stichting DICA. Alle rechten voorbehouden. NABON breast cancer audit (NBCA) jaarverslag uitkomsten 2019. 16 oktober 2020 [Internet]. [cited 2021 Feb 9]. Available from: https://dica.nl/media/2511/NBCAJaarverslag2019.pdfCopyright © 2019 Stichting DICA. Alle rechten voorbehouden. NBCA indicatoren 2019 [Internet]. 2019 [cited 2020 Oct 21]. Available from: https://dica.nl/media/2453/NBCAindicatoren2019.pdfCopyright © 2019 Stichting DICA. Alle rechten voorbehouden. NBCA indicatoren 2019 [Internet]. 2019 [cited 2020 Oct 21]. Available from: https://dica.nl/media/2453/NBCAindicatoren2019.pdfNHS Digital. Breast Screening Programme. [Internet]. [cited 2021 Feb 20]. Available from: https://digital.nhs.uk/dataand-information/publications/statistical/breast-screening-programme/england---2019–20NHS Digital. Breast Screening Programme. [Internet]. [cited 2021 Feb 20]. Available from: https://digital.nhs.uk/dataand-information/publications/statistical/breast-screening-programme/england---2019–20NHS Breast Screening Programme & Association of Breast Surgery. An audit of screen detected breast cancers for the year of screening April 2018 to March 2019 [Internet]. 2020 [cited 2021 Feb 11]. Available from: https://associationofbreastsurgery.org.uk/media/311352/nhs-bsp-abs-audit-2018–2019.pdfNHS Breast Screening Programme & Association of Breast Surgery. An audit of screen detected breast cancers for the year of screening April 2018 to March 2019 [Internet]. 2020 [cited 2021 Feb 11]. Available from: https://associationofbreastsurgery.org.uk/media/311352/nhs-bsp-abs-audit-2018–2019.pdfThe Health Foundation. Breast cancer care Quality indicators. [Internet]. 2019 [cited 2021 Feb 20]. Available from: https://www.health.org.uk/sites/default/files/2019–11/breast_cancer_care_quality_indicators_-_q04a_the_measurement_maze.pdfThe Health Foundation. Breast cancer care Quality indicators. [Internet]. 2019 [cited 2021 Feb 20]. Available from: https://www.health.org.uk/sites/default/files/2019–11/breast_cancer_care_quality_indicators_-_q04a_the_measurement_maze.pdfNICE. Breast cancer. [Internet]. 2016 [cited 2021 Feb 20]. Available from: https://www.nice.org.uk/guidance/qs12/chapter/IntroductionNICE. Breast cancer. [Internet]. 2016 [cited 2021 Feb 20]. Available from: https://www.nice.org.uk/guidance/qs12/chapter/IntroductionNABCOP. Healthcare Quality Improvement Partnership. National Audit of Breast Cancer in Older Patients [Internet]. London; 2020 [cited 2021 Feb 8]. Available from: https://www.nabcop.org.uk/NABCOP. Healthcare Quality Improvement Partnership. National Audit of Breast Cancer in Older Patients [Internet]. London; 2020 [cited 2021 Feb 8]. Available from: https://www.nabcop.org.uk/NHS. National Mastectomy and Breast Reconstruction Audit, Annual Report [Internet]. [cited 2021 Feb 11]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-mastectomy-and-breastreconstruction-audit-annual-reportNHS. National Mastectomy and Breast Reconstruction Audit, Annual Report [Internet]. [cited 2021 Feb 11]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-mastectomy-and-breastreconstruction-audit-annual-reportThe Royal College of Surgeons of England. National Mastectomy and Breast Reconstruction Audit — Fourth Report [Internet]. 2011 [cited 2021 Feb 8]. Available from: https://www.rcseng.ac.uk/library-and-publications/rcspublications/docs/mastectomy-breast-4/The Royal College of Surgeons of England. National Mastectomy and Breast Reconstruction Audit — Fourth Report [Internet]. 2011 [cited 2021 Feb 8]. Available from: https://www.rcseng.ac.uk/library-and-publications/rcspublications/docs/mastectomy-breast-4/Jeevan R. Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England. Ann R Coll Surg Engl. 2020 Feb;102 (2):110–4.Jeevan R. Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England. Ann R Coll Surg Engl. 2020 Feb;102 (2):110–4.The Association of Breast Surgery. UK National Flap Registry [Internet]. 2021 [cited 2021 Feb 11]. Available from: https://associationofbreastsurgery.org.uk/The Association of Breast Surgery. UK National Flap Registry [Internet]. 2021 [cited 2021 Feb 11]. Available from: https://associationofbreastsurgery.org.uk/

The authors declare that there are no conflicts of interest present.