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Changes in Korean National Healthcare Insurance Policy and Breast Cancer Surgery Trend in Korea
Rayzah Musaed,Ryu Jai Min,Lee Jun-Hee,Nam Seok Jin,Kim Seok Won,Lee Se Kyung,Yu Jonghan,Lee Kyeong-Tae,Bang Sa-Ik,Mun Goo-Hyun,Pyon Jai-Kyong,Jeon Byung-Joon,Lee Jeong Eon 대한의학회 2021 Journal of Korean medical science Vol.36 No.29
Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion: IBR rate in patients undergoing TM increased after NHI reimbursement.
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Musaed Rayzah,Jai Min Ryu,Jeong Eon Lee,Mansour Alramadhan,Bookyung Han,Ha Woo Yi,박승민,백현준,남석진 한국유방암학회 2016 Journal of Breast Disease Vol.4 No.2
Purpose: The purpose of this study was to determine whether magnetic resonance imaging (MRI) could assess the size of ductal carcinoma in situ (DCIS) more accurately compared to mammography and ultrasonography using the histopathological dimension of the surgical specimen as the reference measurement. Methods: This was a retrospective review study using data from our institution database of breast cancer. Preoperative contrast-enhanced MRI, mammography and ultrasonography were performed to detect and assess the size of DCIS in 131 patients. The greatest dimensions of DCIS determined by the imaging modalities were compared with the histopathological dimensions of the surgical specimens. Intraclass coefficients were calculated to examine the agreement among the MRI, mammography and ultrasonography measurements. The Wilcoxon signed-rank test was used to evaluate the statistical significance of the differences in size among MRI, mammography or ultrasonography and histopathology findings. Results: Of the 131 DCIS lesions, 126 (96.2%) were detected by MRI, 103 (78.6%) were detected by mammography, and 121 (92.4%) were detected by ultrasonography. The mean lesion size was 38.8 mm on histopathology, 36.0 mm on MRI, 28.8 mm on mammography, and 23.3 mm on ultrasonography, and there were no significant differences between sizes determined by histopathology and MRI, while there were significant differences between histopathology and the other modalities. The correlation coefficient between histopathological measurement and MRI was 0.837, versus 0.461 between histopathology and mammography and 0.284 between histopathology and ultrasonography. The lesion size was correctly estimated (±5 mm), under-estimated (<5 mm), or over-estimated (>5 mm), respectively, by MRI in 52.7%, 30.5%, and 16.8% of cases; by mammography in 32.0%, 51.2%, and 16.8% of cases, respectively; and by ultrasonography in 24.4%, 62.6%, and 13.0% of cases, respectively. Conclusion: In our study, MRI was more accurate for detection and assessment the size of DCIS compared to mammography and ultrasonography.
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Alramadhan, Mansoor,Ryu, Jai Min,Rayzah, Musaed,Nam, Seok Jin,Kim, Seok Won,Yu, Jonghan,Lee, Se Kyung,Bae, Soo Youn,Park, Sungmin,Paik, Hyun-June,Lee, Jeong Eon Elsevier 2016 The Breast Vol.30 No.-
<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>To study the outcomes of adjuvant goserelin combined with tamoxifen (GosTam) compared to chemotherapy followed by tamoxifen (ChemTam) in premenopausal patients with early stage, luminal A breast cancer.</P> <P><B>Methods</B></P> <P>From 2008 until 2013, data were retrospectively collected for premenopausal patients who underwent surgery for invasive tumors that were ≤2.0 cm, node-negative, strongly positive for estrogen and progesterone receptors, HER-2-negative, and Ki-67 < 25%. The patients were divided into two groups according to adjuvant regimen, either GosTam or ChemTam. All patients who underwent different adjuvant regimens were excluded.</P> <P><B>Results</B></P> <P>In total, 235 patients underwent GosTam and 171 patients underwent ChemTam. There were significantly more patients younger than 40 years in the GosTam group (32% GosTam vs. 22% ChemTam, p = 0.031). Mean tumor size was significantly smaller (1.19 cm vs. 1.48 cm, p < 0.001), Ki-67 significantly lower (p = 0.049), and nuclear grade was low in a significant number of patients in the GosTam group (2% vs. 13%, p < 0.001). After a median follow-up of 51.3 months, there was no mortality in either group. There was no significant difference in 5-year disease-free survival (DFS) between the two groups even after univariate analysis considering age, tumor size, nuclear grade, and P53% (GosTam = 98.9% vs. ChemTam = 95.7%, HR = 0.404, 95% CI = [0.073, 2.222], p = 0.248).</P> <P><B>Conclusion</B></P> <P>There was no difference between treatment groups, and neither chemotherapy nor ovarian suppression seemed to improve the outcome. Thus, tamoxifen alone might be a sufficient option for this low-risk patient population.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Management of premenopausal patients with luminal A breast cancer is controversial. </LI> <LI> Luminal A breast cancer patients are less responsive to chemotherapy. </LI> <LI> Ovarian suppression has no added value over tamoxifen in low risk patient group. </LI> <LI> Low risk luminal A breast cancer patients might be treated with adjuvant tamoxifen alone with good disease control. </LI> </UL> </P>
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