Annelotte van Bommel

45 The indicator breast-contour-preserving procedure INTRODUCTION The quality of breast cancer treatment has received considerable attention in recent years. Identification of parameters that represent quality of breast cancer care is challenging. As survival rates for patients with primary breast cancer have improved considerably over the recent decades 1 and local recurrence rates have decreased significantly, 2 more effort is being directed to improve esthetic outcomes, reflecting an important aspect of quality of life. Previously, the proportion of patients undergoing breast conserving surgery (BCS) has been used as a parameter reflecting esthetic outcome in breast cancer treatment. Recent population-based studies report stable BCS rates over the past years of approximately 60%, 3,4 suggesting that esthetic outcomes of local treatment may not have improved over recent years. Nonsurgical treatment modalities contribute to local esthetic outcome as well. The use of neo-adjuvant systemic therapy influences the ability to perform BCS. 5,6 Moreover, immediate breast reconstruction following mastectomy (IBR) or delayed breast reconstruction may also lead to desirable esthetic outcomes. Both neo-adjuvant chemotherapy (NAC) and IBR are increasingly being used, 4 and institutional preferences regarding the use of the former and surgical expertise with the latter have an impact on the surgical choice for BCS or mastectomy. A parameter that comprises the combined efforts to preserve the breast contour may therefore be more appropriate to evaluate local esthetic outcome in breast cancer treatment. For this purpose, we defined ‘‘breast-contour-preserving procedure (BCPP)’’ as a parameter that encompasses all strategies to preserve the contour of the breast (primary BCS, BCS after NAC, and mastectomy with IBR). Within the NABON Breast Cancer Audit (NBCA), 3 we explored BCPP as a local outcome parameter by evaluating trends over time in relation to age, and compared the frequencies of BCPP with primary BCS rates. 3