1 in 4 Breast Cancer Lumpectomies Requires Follow-Up Surgery
Risk after breast-conserving operation is lower with 'high-volume' surgeons, researchers say
By Kathleen Doheny
WEDNESDAY, Feb. 17, 2016 (HealthDay News) -- Women with early stage breast cancer who opt for a breast-conserving surgery known as a lumpectomy have a one in four chance they will need a second operation within 90 days, researchers report.
"The chance of getting a second surgery has gone down a little, but it is still high and it is substantial," said study author Dr. Art Sedrakyan. He is a professor of health care policy and research at Weill Cornell Medicine in New York City.
In a lumpectomy, the tumor tissue, along with a margin of surrounding tumor-free tissue, is removed. However, if the tissue in the margin is not completely free of tumor cells, a second operation is needed.
During the study period, which ran from 2003 through 2013, the overall rate of re-operation within 90 days was almost 31 percent, Sedrakyan said. It declined from nearly 40 percent in 2003 through 2004, to 23 percent from 2011 through 2013, the study found.
"Having a second surgery after you think you've solved all your problems is stressful," Sedrakyan said.
The question of how often women need a repeat surgery is critical for a number of reasons, Sedrakyan explained. These reasons include letting women know the risk of re-operation if they choose breast-conservation surgery. Doctors also need to know the risk so they can come up with guidance to help reduce that risk, he said.
"Patients operated on by higher-volume doctors had a lower chance of getting this re-operation," Sedrakyan said. High-volume surgeons were defined as those who had 34 or more cases a year, on average, while low-volume surgeons had 13 or fewer cases. The lowered risk with high-volume doctors was about 33 percent, the study findings showed.
The study appears in the Feb. 17 online edition in the journal JAMA Surgery.
The researchers evaluated data on nearly 90,000 women who had lumpectomies in hospitals and ambulatory surgery centers in New York. The rates of re-operation were highest among those aged 20 to 49 and lowest in those aged 65 and older.
"We need to make sure women know about this risk, and are making informed decisions," Sedrakyan said. He believes the data, while gathered only from one state, New York, would be applicable to other regions of the United States.
Dr. Anthony Echo, an assistant professor of plastic surgery at Houston Methodist Hospital in Texas, agreed.
The decline found in re-operation rates in the study is probably due to a number of factors, Echo said. They include better training of breast surgeons and the team approach now used at many hospitals.
"There is much more knowledge," Echo said. And some radiologists and pathologists now dedicate their practices to breast cancer, he added.
The team approach may indeed help explain the decline, along with better techniques, Sedrakyan said. In addition, new guidelines from the Society of Surgical Oncology and the American Society for Radiation Oncology specifying when re-operation is needed may further reduce the second surgery rates, the study authors suggested.
To learn more about breast-conservation surgery, see the American Cancer Society.
SOURCES: Art Sedrakyan, M.D., Ph.D., professor, health care policy and research, Weill Cornell Medicine, New York City; Anthony Echo, M.D., assistant professor, plastic surgery, Houston Methodist Hospital; Feb. 17, 2016, JAMA Surgery, online
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