# Shaping Breast Cancer Treatment in Resource-Limited Settings: Influence of AMAROS and ACOSOG Z0011 Trials in a Follow-up Audit

## TL;DR

This study examines how breast cancer treatment practices have evolved in a resource-limited setting following influential clinical trials.

## Contribution

It shows increased adoption of less invasive surgeries and guideline-aligned practices despite limited resources.

## Key findings

- Early-stage diagnoses increased from 14.2% to 27.9% over the study period.
- Breast-conserving surgery rose from 6% to 20.3% between 2022 and 2024.
- AMAROS and ACOSOG Z0011 guidelines influenced reduced use of axillary lymph node dissection in early-stage cases.

## Abstract

Introduction

Trials like AMAROS and ACOSOG Z0011 have modified the approach to sentinel lymph node biopsy (SLNB) in node-positive and node-negative breast cancer. This study evaluates evolving surgical trends in breast cancer management at a resource-limited setting with respect to such trials.

Methods

A follow-up retrospective audit of breast cancer surgeries performed over a three-year period was conducted and compared with the first cycle of audit in the 2017-2021 period. Formal approval was taken from the Ethical Review Board (ERB) of Allama Iqbal Medical College/Jinnah Hospital, Lahore, in its 179th meeting, dated 23-12-2024, with Ref No: ERB179/5(i)/23-12-2024/S1 ERB. Operative records of 273 breast cancer patients treated between 2022 and 2024 were reviewed. Data on age, stage at presentation, and type of surgery were extracted. Surgical procedures included modified radical mastectomy (MRM), breast-conserving surgery (BCS), and SLNB, with or without axillary lymph node dissection (ALND). Analysis was conducted using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) to observe trends and compare with the previous audit results.

Results

A majority (70.7%, n=191) of patients presented with Stage III disease, with most cases occurring in the 41-60 age group. Early-stage diagnoses (Stages I and II) increased from 14.2% in the previous audit to 27.9% in this cycle. MRM remained the predominant procedure (72.9%, n=199), though its use declined from 85% in the prior audit to 70% currently. BCS increased from 6% (n=3) in 2022 to 20.3% (n=26) in 2024. Among early-stage patients undergoing BCS with SLNB, 70% (n=28) underwent ALND, while 30% (n=12) did not, reflecting increased adoption of AMAROS and ACOSOG Z0011 guidelines. These trends indicate a progressive shift toward less invasive and guideline-aligned breast cancer management.

Conclusion

The study demonstrates progress in the adoption of conservative breast cancer treatments, despite resource constraints. Emphasis on early detection, adherence to updated guidelines, and periodic audits is critical to improving outcomes in low-resource settings.