• Ramsey I Cutress, Stuart A McIntosh, Shelley Potter, Amit Goyal, Cliona C Kirwan, James Harvey, Adele Francis, Amtul R Carmichael, Raghavan Vidya, Jayant S Vaidya, Patricia Fairbrother, John R Benson, ReedMalcolm W RMWRBrighton and Sussex Medical School, University of Sussex, Brighton, UK., and Association of Breast Surgery Surgical Gap Analysis Working Group.
• Faculty of Medicine and Breast Unit, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, UK. Electronic address: r.i.cutress@soton.ac.uk.
• Lancet Oncol. 2018 Oct 1; 19 (10): e521-e533.

AbstractThe 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery). Section leads were identified based on research interests, with invited input from experts in specific areas, supported by consultation with members of the Association of Breast Surgery and Independent Cancer Patients' Voice groups. The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Key research gaps included issues surrounding overdiagnosis and treatment; optimising treatment options and their selection for neoadjuvant therapies and subsequent surgery; reducing rates of re-operations for breast-conserving surgery; generating evidence for clinical effectiveness and cost-effectiveness of breast reconstruction, and mechanisms for assessing novel interventions; establishing optimal axillary management, especially post-neoadjuvant treatment; and defining and standardising indications for risk-reducing surgery. We propose strategies for resolving these knowledge gaps. Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and health-care systems. Development of infrastructure and surgical research capacity, together with appropriate allocation of research funding, is needed to successfully address the key clinical and translational research gaps that are highlighted in this Review within the next two decades.Copyright © 2018 Elsevier Ltd. All rights reserved.

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