1 in 4 breast-conserving procedures lead to repeat surgery

A new study in JAMA Surgery shows that roughly 25% of women with breast cancer who undergo conservative surgery will undergo a subsequent procedure to establish negative margins. The findings suggest that the rate of repeat procedures varies by patient, tumor, and facility.

Data on patients diagnosed with breast cancer at a Commission on Cancer-accredited center between January 1, 2004 to December 31, 2010 and identified using the National Cancer Data Base were used in the analysis. The study included 316,114 patients with Stages 0 to II breast cancer who had initial breast conservation surgery. Women who received neoadjuvant treatment or who were diagnosed by excisional biopsy were excluded.

Overall, a total of 241,597 patients (76.4%) had a single lumpectomy. Nearly 24% of the women (74, 517) underwent at least 1 additional operation, of whom 46,250 (62.1%) had completion lumpectomy and 28,267 (37.9%) had mastectomy. Over the course of the study period, the proportion of patients who underwent repeat surgery slightly decreased, from 25.4% to 22.7% (P<.001).

Independent predictors of repeat surgeries included node status, tumor grade, facility type and location, race, insurance status, pathologic tumor size, volume of breast cancer cases, estrogen receptor status, histologic subtype, comorbidities, and age. Repeat surgeries were inversely associated with age, falling from 38.5% in patients ages 18 to 29 years to 16.5% in those older than 80 (P<.001). Larger tumor size was linearly associated with higher rates of repeat surgery (P<.001).

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Repeat operations were less common in facilities in the Mountain region, where only 18.4% of patients underwent the procedures, whereas 26.5% of patients had repeat surgeries in Northeast region facilities (P<.001). For community facilities, the rate of repeat surgeries was 22.4%, versus 26.0% rate for academic facilities (P<.001).

The researchers concluded that approximately 25% of all patients who have initial breast conservation surgery will have a subsequent surgery. They noted that the rate of repeat surgeries decreased somewhat over the past 6 years.

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