Tulin Cil

Tulin Cil
The Princess Margaret Hospital · Department of Surgical Oncology

MD, MEd

About

101
Publications
7,447
Reads
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1,425
Citations
Citations since 2017
59 Research Items
1150 Citations
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2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
Additional affiliations
July 2008 - August 2020
University of Toronto
Position
  • Professor (Associate)
Description
  • Gattuso Chair in Breast Surgical Oncology at UHN
January 2008 - present
Women's College Research Institute
Women's College Research Institute
Position
  • Professor (Assistant)
January 2008 - present
University Health Network
Position
  • Surgeon

Publications

Publications (101)
Article
Full-text available
Background Knowledge of pathogenic variants in cancer-predisposing genes is important when making breast cancer treatment decisions, but genetic testing is not universal and criteria must be met to qualify for genetic testing. The objective of this study was to evaluate the pathogenic variant yield for nine cancer predisposition genes by testing cr...
Article
Objective: Rates of bilateral mastectomy are increasing in women with ductal carcinoma in situ (DCIS). We aim to characterize the trajectory of psychosocial outcomes after surgery in women with DCIS. Methods: We have been prospectively collecting psychosocial data on women receiving surgery for stage 0-III breast cancer at University Health Network...
Article
Background Access to breast imaging was restricted during the first wave of the COVID-19 pandemic. We assessed the impact of healthcare restrictions on the Gattuso Rapid Diagnostic Centre (GRDC) at the Princess Margaret Cancer Centre. Methods A retrospective review of patients seen at the GRDC between March 12 - August 31, 2020 and the correspondi...
Article
Full-text available
Background: COVID-19 has placed demands on General Surgery residents, who are already at high risk of burnout. This study examined the pandemic's impact on burnout and wellness among General Surgery residents at a large training program. Methods: General Surgery residents at our institution completed a survey focused on self-reported burnout, me...
Article
Background The objective of this study was to determine the influence of race/ethnicity and socioeconomic status (SES) on breast cancer outcomes. Methods A retrospective analysis was performed of Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with non-metastatic breast cancer in the SEER cancer registry between 2007 and...
Article
The COVID-19 pandemic has substantially changed the practice of medicine with a shift to virtual clinical encounters, alternative management of surgical diseases owing to restrictions on elective operations, and physician redeployment to other medical services requiring coverage. These changes may limit opportunities for trainees to gain surgical e...
Article
Background Given numerous publications and clinical trials regarding axillary management in breast cancer, we sought to summarize this complex literature to help clarify this field for clinicians. This systematic review focuses on the role of irradiation of the axillary nodes (locoregional nodal irradiation [LRNI]) in the management of the axilla i...
Article
Full-text available
Purpose Some series have shown increased complications with extended nodal surgery and immediate breast reconstruction (IBR) with implants. We aim to explore complications associated with axillary dissection compared to sentinel lymph node biopsy at a population level. Methods American College of Surgeons National Surgical Quality Improvement Prog...
Article
Full-text available
PurposeMany women are being offered rapid genetic testing (RGT) for cancer predisposition genes, at the time of breast cancer diagnosis prior to surgery. The goal of this study was to determine if psychosocial functioning was affected in women receiving RGT for BRCA1 and BRCA2 at the time of breast cancer diagnosis.Methods Participants were women w...
Article
Full-text available
Background: The transition from surgical residency to independent practice is a challenging period that has not been well studied. Methods: An email invitation to complete a 55-item survey and the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) was sent to early career general surgeons across Canada. The chi-square test or Fisher’s exact...
Chapter
The assessment of a patient with breast cancer involves taking a focused history. This includes identification of both the modifiable and non-modifiable risk factors for breast cancer that the patient carries. Most of the modifiable risk factors are related to estrogen. Non-modifiable risk factors include family history and precursor lesions. Physi...
Article
Purpose: To provide recommendations on the best strategies for the management and on the best timing and treatment (surgical and radiotherapeutic) of the axilla for patients with early-stage breast cancer. Methods: Ontario Health (Cancer Care Ontario) and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations in...
Article
There have been recent reports in the breast imaging literature of unilateral axillary lymphadenopathy following COVID-19 vaccination. It is unclear whether the reactive lymphadenopathy may impact the sentinel lymph node biopsy procedure. In this article, we provide guidelines regarding the timing of the COVID-19 vaccine and breast cancer surgery w...
Article
e18551 Background: Racial disparities in breast cancer are well established. However, there is a paucity of literature assessing the interaction of patient, socioeconomic, and community factors on outcomes. The objective of this study was to determine the influence of race/ ethnicity, socioeconomic status (SES), and insurance status on disease pres...
Article
568 Background: In breast cancer, clinicians aim to improve survival while patients value quality of life. We aim to delineate the impact of patient, tumour and treatment factors on psychosocial outcomes after treatment. Methods: A prospective cohort of women with unilateral stage I-III breast cancer were recruited at University Health Network in T...
Article
Racial disparities in breast cancer are well established. However, there is a paucity of literature assessing the interaction of patient, socioeconomic, and community factors on breast cancer care. The objective of this study was to determine the influence of race/ ethnicity, socioeconomic status (SES), and insurance status on disease presentation,...
Article
IntroductionRates of bilateral mastectomy are rising in women with unilateral, nonhereditary breast cancer. We aim to characterize how psychosocial outcomes evolve after breast cancer surgery.Patients and Methods We performed a prospective cohort study of women with unilateral, sporadic stage 0–III breast cancer at University Health Network in Toro...
Article
Background There is an increasing desire for contralateral prophylactic mastectomy (CPM) among patients with unilateral breast cancer. It is unknown if risk assessment and genetic testing at the time of diagnosis will aid women in their surgical choice. We report on the uptake and predictors of CPM in women receiving a negative genetic test result...
Conference Paper
Purpose: To evaluate patient-reported outcomes of adolescents and young adults (AYAs) with breast cancer treated with curative intent. Methods: AYA breast cancer patients (defined as diagnosed between 18 to 39 years of age) treated at a large tertiary cancer centre between January 2014 and December 2016 were identified. Patients routinely complete...
Conference Paper
BACKGROUND: Changes in access to breast imaging and suspension of mammographic screening during the COVID-19 pandemic had the potential to significantly delay breast cancer diagnostic pathways. The Gattuso Rapid Diagnostic Centre (GRDC) is an innovative clinic that provides a patient-centered approach for investigation of suspicious breast abnormal...
Article
Full-text available
Purpose Many women with early-onset breast cancer experience adverse psychological sequelae which impact on their quality of life. We sought to correlate levels of anxiety and cancer-related distress in women with breast cancer shortly after surgery and one year after treatment with the estimated risk of death. Methods We studied 596 women with St...
Article
Deep serratus anterior plane block has been widely adopted as an analgesic adjunct for patients undergoing breast surgery, but robust supporting evidence of efficacy is lacking. We randomly allocated 40 patients undergoing simple or partial mastectomy with sentinel node biopsy to receive either a pre-operative deep serratus anterior plane block (se...
Article
Background Full-thickness chest wall resection (FTCWR) is an underused modality for treating locally advanced primary or recurrent breast cancer invading the chest wall, for which little data exist regarding morbidity and mortality. We examined the postoperative complication rates in breast cancer patients undergoing FTCWR using a large multination...
Article
Background Gender bias is thought to exist in the assessment of clinical teachers, yet its extent in different specialties is not well-documented nor has it been studied at the individual-dyadic level. Objective The authors sought to determine whether gender bias exists in residents' assessments of faculty teaching in 3 clinical departments, and i...
Article
Full-text available
IntroductionThe Ontario High Risk Breast Screening program follows women aged 30–69 at an increased risk of breast cancer, using a yearly mammography and breast MRI. The aim of this study is to determine the clinical outcomes for the enrolled women.Methods Observational cohort study following 2081 participants in the high-risk screening program 201...
Article
Full-text available
Purpose: The goal of this study is to evaluate the frequency and imaging features of lobular neoplasia (LN) diagnosed on MRI-guided biopsy, determine the upgrade rate to malignancy, and assess for any features that may be associated with an upgrade on surgical excision. Materials and methods: Research ethical board approved the review of consecu...
Article
Full-text available
Background: Whether to undergo postmastectomy breast reconstruction (PMBR) is a challenging, preference-sensitive decision. It is therefore paramount to optimize decision quality through ensuring patients' knowledge and aligning treatments with their personal preferences. This study assessed the effects of a preconsultation educational group inter...
Article
Full-text available
Background: Despite the recent surge in rates of immediate breast reconstruction, there is a paucity of large multicenter studies to compare differences in morbidity after immediate versus delayed breast reconstruction. This study used the National Surgical Quality Improvement Program (NSQIP) to study the association between timing of breast recon...
Article
Background: This study aimed to evaluate the impact of rapid genetic testing (RGT) for BRCA1 and BRCA2 at the time of breast cancer diagnosis on treatment choices. Bilateral mastectomy for the treatment of breast cancer in women with a BRCA1 or BRCA2 mutation offers a reduction in the risk of contralateral breast cancer. It is unclear whether offe...
Chapter
Breast cancer is responsible for 26% of all cancers in women and 13% of all cancer-related deaths in women. One in every 8 women is expected to develop breast cancer during her lifetime, and 1 in 31 women will die of breast cancer.
Article
Background: The growing volume of studies of robot-assisted nipple-sparing mastectomy requires critical assessment. This review synthesizes the data on safety, feasibility, oncological and cosmetic outcomes, and patient-reported outcome measures (PROMs) for robot-assisted nipple-sparing mastectomy. Methods: A systematic review was performed usin...
Preprint
UNSTRUCTURED Recently, cases of patients recording clinical encounters without the physician's knowledge have been reported, raising ethical and legal questions. No study to date has examined surgeon's and trainee's attitudes towards this practice. An anonymous online survey was developed and administered to surgeons and trainees in a large academi...
Article
Full-text available
PurposeAlthough there has been a significant increase in the use of oncoplastic surgery (OPS), data on the postoperative safety of this approach are limited compared to traditional lumpectomy. This study aimed to compare the immediate (30-day) postoperative complications associated with OPS and traditional lumpectomy.Methods An analysis of the Amer...
Article
Background Women continue to be underrepresented in academic anesthesiology, especially in leadership positions. Possible reasons for this gender disparity include family responsibilities, inadequate mentorship, lack of desire for leadership, the leaky pipeline effect (i.e., attrition of women physicians over the course of their career trajectories...
Article
Full-text available
Introduction: The understanding of the biology and epidemiology of, and the optimal therapeutic strategies for, breast cancer (bca) in younger women is limited. We present the rationale, design, and initial recruitment of Reducing the Burden of Breast Cancer in Young Women (ruby), a unique national prospective cohort study designed to examine the...
Article
570 Background: Rates of bilateral mastectomy continue to rise in average-risk women with unilateral breast cancer. We aim to characterize psychosocial predictors of surgical procedure and how psychosocial outcomes change over time after surgery for breast cancer. Methods: A prospective cohort of women with unilateral, nonhereditary breast cancer w...
Article
Surgeons are frequently perceived by medical students to be uncompassionate, resolute and individualistic. Surgical education often prioritizes teaching and learning approaches that perpetuate these perceptions. In other specialties, engaging patients in education has shown promise in refocusing attention from the technical and procedural aspects o...
Article
Purpose Neoadjuvant chemotherapy (NAC) is standard of care for locally advanced breast cancer. There is wide variation in radiotherapy (RT) practice and limited data describing locoregional relapse (LRR) following NAC. We hypothesized a low LRR risk with modern NAC, surgery, and RT, and aimed to elucidate patterns of LRR and predictors of disease-f...
Article
Background: Alloplastic breast reconstruction is safe in well-selected older women. The impact of timing of surgery on complication rates is unknown. This study aimed to determine the immediate (30-day) postoperative complication rates of older women who underwent immediate (IBR) and delayed breast reconstruction (DBR) with alloplastic techniques....
Article
Background: The rates of contralateral prophylactic mastectomy (CPM) are increasing in women with breast cancer. Previous retrospective research has examined clinical and demographic predictors of the uptake of CPM. However, to the authors' knowledge, there has been very little prospective research to date that has examined psychosocial functionin...
Article
Full-text available
Purpose The safety of immediate breast reconstruction (IBR) in older women is largely unknown. This study aimed to determine the 30-day postoperative complication rates following IBR (implant-based or autologous) in older women (≥ 70 years) with breast cancer and to compare them to younger women (18–69 years). Methods The National Surgical Quality...
Chapter
Following a recent diagnosis of breast carcinoma, a 33-year-old, G2, P2 woman was referred by her surgeon for discussion of potential effects of cancer therapy on future reproductive function and fertility preservation. She had noted a lump in her left breast 3 months prior and was referred to the rapid breast cancer clinic for evaluation. Mammogra...
Article
Background:Less than 14% of older women undergo post-mastectomy breast reconstruction. A major reason for the low rate is the concern about post-operative complications. A thorough analysis of surgical complications by age group is limited in previous studies. The aim of this study is to determine the surgical complication rates of older women (≥70...
Article
Objective. Breast-conserving therapy with external beam radiotherapy (EBRT) is currently the standard of care for women with early breast cancer. Our aim was to determine if early-stage breast cancers treated with lumpectomy and primary intraoperative radiotherapy (IORT) have comparable local recurrence rates. This is the first study examining the...
Article
Full-text available
Gender preference among patients seeking medical care is an issue that is not well understood. It warrants exploration, particularly for patients undergoing sensitive physical exams. In a recent IJHPR article, Groutz et al. reported a survey study that explored patient preferences in selecting a breast surgeon. They found that a third of patients p...
Article
Full-text available
Background Male breast cancer (MBC) is a rare malignancy, and gender-specific treatment outcomes are currently lacking. The use of a large, multi-national surgical-outcomes database may provide a better understanding of treatment patterns and postoperative morbidity in men who undergo oncological breast surgery. MethodsA retrospective cohort analys...
Article
Full-text available
Background: Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutio...
Article
Full-text available
Purpose: Although the field of medical education research is growing and residents are increasingly recruited to participate as subjects in research studies, little is known about their experiences. The goal of this study was to explore the experiences and perceptions of residents who are study participants in medical education research. Method:...
Article
Full-text available
Purpose: Postoperative complication rates for elderly women undergoing breast cancer surgery have not been well studied. We describe the postoperative complication rates of elderly (≥ 70 years) women with breast cancer and compare them with young (40-69 years) women. Methods: Data were extracted from the National Surgical Quality Improvement Pro...
Article
Background: Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution. Methods: Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery...
Article
Background and objectives: Serratus fascial plane block can reduce pain following breast surgery, but the question of whether to inject the local anesthetic superficial or deep to the serratus muscle has not been answered. This cohort study compares the analgesic benefits of superficial versus deep serratus plane blocks in ambulatory breast cancer...
Article
The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with postoperative radiation, but has evolved to include several options that produce excellent oncologic endpoints and improved cosmesis. These options include skin- and nipple-sparing mas...
Article
Background: Pectoralis and serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or serratus block to conventional opioid-based analgesia (control) in patients who underwent ambulatory breast cancer surgery...
Article
Background: We sought to examine the safety of same-day breast reconstructive (BR) surgery. Methods: An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) files was performed. Patients undergoing BR for breast cancer were examined, excluding those with high-risk co-morbidities or concurrent su...
Article
Background Oncoplastic breast surgery (OBS) aims to provide breast cancer patients with optimum oncologic outcomes and excellent cosmesis. We sought to determine if there is a difference in complications associated with OBS involving soft tissue transfer compared with the traditional breast-conserving surgical (BCS) approach. Methods Analysis of th...
Article
Full-text available
Background: The number of women in surgery has steadily increased, yet their numbers in academic surgery positions and in high-ranking leadership roles remain low. To create strategies to address and improve this problem, it is essential to examine how gender plays into the advancement of a woman's career in academic surgery. Methods: Focus grou...
Article
Background Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. Methods A 13-item survey w...
Article
Aim: To examine trends of contralateral prophylactic mastectomy (CPM) rates at a Canadian academic breast cancer center. Methods: A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy (UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010...
Chapter
Breast cancer is responsible for 26 % of all cancers in females and 14 % of all cancer-related deaths in females. 1 in every 9 women is expected to develop breast cancer during her lifetime and 1 in 30 women will die of breast cancer. The surgical management of breast cancer requires an understanding of the complete spectrum of breast pathology, bo...
Article
Objectives: The information needs of cancer patients are highly variable. Literature suggests an improved ability to modulate personalised stress, increased patient involvement with decision making, greater satisfaction with treatment choices and reduced anxiety levels in cancer patients who have access to information. The aim of this project was...
Article
Background: Text messaging (texting) has become a routine medium of communication in society. However, its use among clinicians has not been fully characterized. We explored general surgery residents' practices and views on texting for patient-related communication. Methods: An email survey was distributed to all general surgery residents at a l...
Article
Background: The purpose of this study was to explore career satisfaction and advancement for women in academic surgery. Methods: A 48-item web-based survey was emailed to women surgeons in academic centers across Canada, exploring career advancement, family planning, mentorship, discrimination, and career satisfaction. Results: The survey resp...
Article
Methods: An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) participant user files from 2005-2012 was performed. Patients undergoing surgery for invasive breast cancer were included; those with high-risk comorbidities or concurrent surgery were excluded. The primary outcome was a composite of...
Conference Paper
Background: Neoadjuvant chemotherapy (NAC) is increasingly used in the treatment of breast cancer. The primary objective of this study was to determine whether administration of NAC increased the proportion of overall 30-day post-operative complications among patients undergoing surgery for invasive breast cancer. Methods: An analysis of the Americ...
Article
Full-text available
Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions prov...
Article
Full-text available
The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial led to a significant change in the management of patients with early stage breast cancer and limited sentinel lymph node (SLN) metastases. However, only 27 patients with invasive lobular carcinoma (ILC) were randomized to the completion axillary lymph node dissection (ALND) arm. T...
Article
Full-text available
Nipple-sparing prophylactic mastectomy (PM) is an option for women at high-risk for breast cancer, and may offer better cosmetic results than a skin-sparing PM where the nipple-areolar complex (NAC) is removed. However, there may be residual breast cancer risk due to the maintained NAC. It is unclear if sparing the NAC with PM impacts on psychosoci...
Conference Paper
Introduction: Most patients undergoing significant breast cancer surgery stay in hospital postoperatively. We sought to determine whether there was a difference in complication rates among patients undergoing same-day surgery (SDS) versus overnight or inpatient stay. Methods: Analysis of the American College of Surgeons, National Surgical Qualit...
Article
Investigating protective strategies against chronic neuropathic pain (CNP) following breast cancer surgery entails using valid screening tools. The DN4 (Douleur Neuropathique en 4 questions) is one tool that offers important research advantages. This prospective six-month follow-up study seeks to validate the DN4 and assess its responsiveness in sc...
Article
Full-text available
Background Four percent of breast cancer patients present with metastatic disease. To date, no one has examined whether these patients are at higher risk of postoperative complications. The objective of this study was to determine morbidity and mortality associated with breast surgery in the metastatic setting. Methods We analyzed the American C...