Many Breast Cancer Patients Had Repeat Surgeries

Breast conservation surgery patients often had repeat surgeries for breast cancer

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Many breast cancer patients have surgery to remove the cancer, but several types of surgery are available. A new study suggests that one type of surgery may lead to more operations down the road.

The study found that almost a quarter of patients who had breast conservation surgery had another operation later.

According to the American Cancer Society, most women with breast cancer will have surgery, but several different surgical options are available. For instance, in breast conservation surgery, only part of the breast is removed. In mastectomy, the entire breast is removed.

The authors of this new study, led by Lee G. Wilke, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, wanted to explore the nature of repeat surgeries after breast conservation surgery.

To do so, Dr. Wilke and team used data from the National Cancer Data Base to identify 316,114 breast cancer patients who had breast conservation surgery. The patients all had stage 0 to 2 breast cancer.

Of these patients, 23.6 percent — almost one quarter — had at least one additional surgery.

Of the patients who had repeat surgeries, 62.1 percent had a "completion lumpectomy" — another breast conserving surgery removing only a portion of the breast. The remaining 37.9 percent had a mastectomy. Both of these surgery types suggest that the patients underwent a repeat operation due to their cancer coming back.

Over the course of the study period, the rate of repeat surgeries slightly decreased — from 25.4 percent of patients in 2004 to 22.7 percent in 2010.

Younger patients and those with larger tumors were more likely to have repeat surgery, the study authors found. Only 16.5 percent of patients older than 80 had repeat surgery — compared to 38.5 percent of patients between the ages of 18 and 29.

The rate of repeat surgeries also differed in different regions of the US and types of facilities. Certain types of tumors were tied to higher rates of repeat surgeries, including ductal carcinoma in situ (cancers that started in the milk ducts without spreading) and invasive lobular carcinoma (cancer that began in the milk-producing lobules and spread to surrounding tissue). Larger tumors were also tied to higher rates of repeat surgeries.

Further research is needed to better understand how these factors might affect repeat surgery, the authors noted.

"These findings can be used by surgeons to better inform their patients regarding repeat surgery rates and how patient or tumor characteristics influence these rates," Dr. Wilke and colleagues wrote.

In an editorial accompanying the study, Julie A. Margenthaler, MD, from the Washington University School of Medicine in St. Louis, and Aislinn S. Vaughan, MD, of the Sisters of St. Mary's Breast Care in St. Charles, MO, wrote that they hoped these findings would affect how breast cancer surgery is approached.

"... [Additional] operations increase health care costs, misuse of resources, patient anxiety, and delay in [early] therapy," Drs. Margenthaler and Vaughan wrote. "With more than 200,000 new invasive breast cancers diagnosed each year, a staggering number of women are undergoing procedures that are unnecessary and simply wasteful."

The study and editorial were published Nov. 12 in JAMA Surgery.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
November 11, 2014
Last Updated:
November 15, 2014