title: A study comparing two consecutive historical periods in breast cancer with a focus on surgical treatment, loco-regional recurrence, distant metastases and mortality.
abstract: OBJECTIVE
  Recent introduction of breast units, mass-screening programmes (SP) and sentinel node biopsy (SNB) has impacted on the clinical care of breast cancer patients (BC), resulting in a significant increase of breast-conserving surgery with the goal of achieving completely free margins and good cosmetic outcome, along with significantly less axillary morbidity. In order to ascertain the combined impact of SP and SNB on BC patients, we have reviewed the primary therapeutic approach of patients diagnosed with invasive breast carcinoma in our centre, both before and after implementation of the two new procedures.
  
  
  METHODS
  1,942 patients operated for BC between 1997 and 2013 in two clinical centres. Two historical periods were considered: before and after the advent of the Breast Unit in our institutions and the concurrent implementation of SP and SNB (September 2002).
  
  
  RESULTS
  Rates of breast-conserving surgery and re-operations improved in the second period. Intraoperative margin re-excision increased in the second period. Breast-conserving surgery decreased in parallel to stage: from 79 % for stage I to 31 % for stage III. The Cox analysis, including stage as adjusted for all significant variables, showed statistically significant differences in favour of the initial stages but only for specific mortality, not overall mortality.
  
  
  CONCLUSIONS
  Combined implementation of breast units, SP, and SNB have resulted in a significant improvement of BC treatment leading to increased rates of breast-conserving surgery and decreased disease recurrence and mortality.
authors.affiliation: Breast Unit, Department of Gynecology, CTD, OTC, Programa detección Precoz Cáncer de Mama, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni 20, 08221, Terrassa, Barcelona, Spain, drgarciafdez@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: García-Fernández
authors.forename: C
authors.initials: C
authors.lastname: Chabrera
authors.forename: M
authors.initials: M
authors.lastname: García-Font
authors.forename: M
authors.initials: M
authors.lastname: Fraile
authors.forename: I
authors.initials: I
authors.lastname: Barco
authors.forename: S
authors.initials: S
authors.lastname: González
authors.forename: L
authors.initials: L
authors.lastname: Cirera
authors.forename: J M
authors.initials: JM
authors.lastname: Lain
authors.forename: C
authors.initials: C
authors.lastname: González
authors.forename: E
authors.initials: E
authors.lastname: Veloso
authors.forename: L
authors.initials: L
authors.lastname: Codina
authors.forename: M
authors.initials: M
authors.lastname: Piqueras
authors.forename: A
authors.initials: A
authors.lastname: Pessarrodona
authors.forename: N
authors.initials: N
authors.lastname: Gimenez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008403:Mass Screening; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D055815:Young Adult