Patients Undergoing Breast Conservation Surgery Likely to Require Subsequent Surgery for Breast Cancer

A recent study found that approximately one-fourth of all patients who undergo initial breast conservation surgery for breast cancer will have a subsequent operative intervention [JAMA Surg. 2014; DOI:10.1001/jamasurg.2014.926]. The rate of repeat surgeries varied by patient, tumor, and facility factors and has decreased slightly during the past 6 years, according to the study.

Although complete excision of breast cancer is accepted as the best means to reduce local recurrence and improve patient survival, there is currently no standard margin width for breast conservation surgery. Thus, significant variability exists in the number of additional operations or repeat surgeries patients undergo to establish tumor-negative margins.

In the study, the researchers, led by Lee G. Wilke, MD, University of Wisconsin School of Medicine and Public Health, Madison, sought to determine the patient, tumor, and facility factors that influence repeat surgery rates in US patients undergoing breast conservation surgery.

Patients who were diagnosed as having breast cancer at a Commission on Cancer accredited center from January 1, 2004, through December 31, 2010, were included in the study. Patients were identified via the National Cancer Data Base, a large observational database. A total of 316,114 patients with stage 0 to stage 2 breast cancer who underwent initial breast conservation surgery were included in the study. Patients who were neoadjuvantly treated or those whose conditions were diagnosed by excisional biopsy were excluded from the study.

The researchers found that a total of 241,597 patients (76.4%) underwent a single lumpectomy, whereas 74,517 (23.6%) underwent at least 1 additional operation, of whom 46,250 (62.1%) underwent a completion lumpectomy and 28,267 (37.9%) underwent a mastectomy. T

he proportion of patients undergoing repeat surgery decreased slightly during the study period from 25.4% to 22.7% (P<.001).

Independent predictors of repeat surgeries were age, race, insurance status, comorbidities, histologic subtype, estrogen receptor status, pathologic tumor size, node status, tumor grade, facility type and location, and volume of breast cancer cases. Age was inversely associated with repeat surgery, decreasing from 38.5% in patients 18 to 29 years of age to 16.5% in patients ≥80 years of age (P<.001).

However, larger tumor size was linearly associated with a higher repeat surgery rate (P<.001). Academic or research facilities had a 26% repeat surgery rate compared with a rate of 22.4% at community facilities (P<.001).

Julie A. Margenthaler, MD, Washington University School of Medicine, St. Louis, and Aislinn S. Vaughan, MD, Sisters of St. Mary’s Breast Care, St. Charles, Missouri compiled an editorial piece to accompany the study, concluding, “[Additional] operations increase healthcare costs, miscues of resources, patient anxiety, and delay in [early] therapy. With >200,000 new invasive breast cancers diagnosed each year, a staggering number of women are undergoing procedures that are unnecessary and simply wasteful.—Kerri Fitzgerald