TY - JOUR
T1 - SMALL
T2 - open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer-protocol for a phase III randomised multicentre trial
AU - Elder, Kenneth
AU - Coles, Charlotte
AU - Dodwell, David
AU - Elsberger, Beatrix
AU - Foster, Jessica
AU - Gaunt, Claire
AU - Henderson, Julia R
AU - Lyburn, Iain
AU - Mabena, Claire
AU - Morgan, Jenna
AU - Nabi, Zohal
AU - Paramasivan, Sangeetha
AU - Pinder, Sarah
AU - Pirrie, Sarah
AU - Potter, Shelley
AU - Roberts, Tracy
AU - Sharma, Nisha
AU - Southgate, Elizabeth
AU - Stobart, Hilary
AU - Talwalkar, Amruta
AU - Taylor-Phillips, Sian
AU - Teh, William
AU - Turner, Elliot
AU - Wallis, Matthew G
AU - Rea, Dan
AU - McIntosh, Stuart
N1 - © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
PY - 2025/4/8
Y1 - 2025/4/8
N2 - INTRODUCTION: Mammographic screening identifies many women with small breast cancers with favourable biological features, which have an excellent prognosis. Some of these may never have become clinically apparent without screening and are commonly described as 'overdiagnosed' cancers. Despite this, all patients with screen-detected cancers are currently treated with surgical excision and sentinel lymph node biopsy, although this may represent overtreatment. There is, therefore, a need for less invasive approaches to reduce treatment burden for patients while maintaining current excellent oncological outcomes. Vacuum-assisted excision (VAE) may represent such an alternative treatment approach, and the SMALL (Open Surgery versus Minimally invasive-vacuum Assisted excision for smaLL screen-detected breast cancer) trial aims to investigate the use of VAE for the safe de-escalation of surgical treatment for such excellent prognosis invasive breast cancers.METHODS: SMALL is a prospective, multicentre, randomised phase III trial of VAE versus surgery in patients with small, biologically favourable screen-detected invasive breast cancer. SMALL has an innovative hybrid design with coprimary endpoints. These include a randomised non-inferiority comparison of surgical re-excision rates following initial treatment, and a single-arm analysis of local recurrence at 5 years following VAE. Secondary outcomes include complication rates, overall survival, quality of life and a health economic analysis. The trial includes a QuinteT Recruitment Intervention to support recruitment.ETHICS AND DISSEMINATION: Ethical approval was obtained from the Office for Research Ethics (Northern Ireland) for all UK sites. Results will be submitted for publication in a peer-reviewed journal, presented, shared with patient partners and with relevant professional organisations to inform future guideline development for the management of screen-detected breast cancer.TRIAL REGISTRATION NUMBER: ISRCTN12240119.
AB - INTRODUCTION: Mammographic screening identifies many women with small breast cancers with favourable biological features, which have an excellent prognosis. Some of these may never have become clinically apparent without screening and are commonly described as 'overdiagnosed' cancers. Despite this, all patients with screen-detected cancers are currently treated with surgical excision and sentinel lymph node biopsy, although this may represent overtreatment. There is, therefore, a need for less invasive approaches to reduce treatment burden for patients while maintaining current excellent oncological outcomes. Vacuum-assisted excision (VAE) may represent such an alternative treatment approach, and the SMALL (Open Surgery versus Minimally invasive-vacuum Assisted excision for smaLL screen-detected breast cancer) trial aims to investigate the use of VAE for the safe de-escalation of surgical treatment for such excellent prognosis invasive breast cancers.METHODS: SMALL is a prospective, multicentre, randomised phase III trial of VAE versus surgery in patients with small, biologically favourable screen-detected invasive breast cancer. SMALL has an innovative hybrid design with coprimary endpoints. These include a randomised non-inferiority comparison of surgical re-excision rates following initial treatment, and a single-arm analysis of local recurrence at 5 years following VAE. Secondary outcomes include complication rates, overall survival, quality of life and a health economic analysis. The trial includes a QuinteT Recruitment Intervention to support recruitment.ETHICS AND DISSEMINATION: Ethical approval was obtained from the Office for Research Ethics (Northern Ireland) for all UK sites. Results will be submitted for publication in a peer-reviewed journal, presented, shared with patient partners and with relevant professional organisations to inform future guideline development for the management of screen-detected breast cancer.TRIAL REGISTRATION NUMBER: ISRCTN12240119.
KW - Humans
KW - Breast Neoplasms/surgery
KW - Female
KW - Vacuum
KW - Minimally Invasive Surgical Procedures/methods
KW - Prospective Studies
KW - Early Detection of Cancer
KW - Randomized Controlled Trials as Topic
KW - Multicenter Studies as Topic
KW - Mammography
KW - Clinical Trials, Phase III as Topic
KW - Neoplasm Recurrence, Local
U2 - 10.1136/bmjopen-2025-099702
DO - 10.1136/bmjopen-2025-099702
M3 - Article (Academic Journal)
C2 - 40204306
SN - 2044-6055
VL - 15
JO - BMJ Open
JF - BMJ Open
IS - 4
M1 - e099702
ER -
