Breast Conservation Surgery Often Requires Further Interventions

A new study reveals that patients undergoing breast conservation surgery (BCS) have high repeat surgery rates, probably due to a lack of consensus on sufficient margin width.

Researchers at the University of Wisconsin (Madison, USA) analyzed data from the US National Cancer Data Base regarding 316,114 patients who underwent BCS from 2004–2010, excluding patients initially treated with chemotherapy or those diagnosed by excision biopsy. The results showed that 76.4% of the patients underwent a single lumpectomy, compared with 23.6% having at least one additional operation after their BCS. The researchers found that the number of patients undergoing additional procedures decreased over time, from 25.4% to 22.7%.

The study showed that of the repeat surgery, 62.1% of patients had a completion lumpectomy, while 37.9% required a mastectomy. Rates of repeat surgery varied between different institutions; academic centers were 19% more likely to perform further operations than community centers. Other independent predictors of repeat surgeries were age, race, insurance status, comorbidities, histologic subtype, estrogen receptor status, pathologic tumor size, node status, tumor grade, and volume of breast cancer cases.

Age was inversely associated with repeat surgery, decreasing from 38.5% in patients 18 to 29 years old to 16.5% in those older than 80 years. In contrast, larger tumor size was linearly associated with a higher repeat surgery rate. When examined geographically, facilities in the Mountain region were significantly less likely to perform repeat surgery compared with those in the Northeastern United States, with respective rates of 18.4% and 26.5%. The study was published on November 12, 2014, in JAMA Surgery.

“At the root of the variability in repeat surgery rates for BCS is the lack of standardization of an acceptable margin width. The tumor margin width that will provide the lowest local recurrence rate has not been established in a randomized clinical trial setting,” concluded lead author Lee Wilke, MD, and colleagues of the School of Medicine and Public Health. “Until recently, no nationally or internationally accepted guidelines for an adequate margin width for invasive or noninvasive breast cancer have been available. This lack of a consensus has led to variable rates of re-excision and ranges in rates of 0% to 60%.”

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