Breast Cancer Surgery Often Repeated To Take Out More Tissue

22.9% of breast cancer patients who undergo partial mastectomies need further operations to remove more tissue, researchers reported in JAMA (Journal of the American Medical Association). The authors, from Michigan State University, added that rates of reexcision vary considerably between surgeons and clinics/hospitals; this variation does not appear to be caused by patients' clinical characteristics.

"Excision" means the surgical removal of something, which in this text means a tumor. "Reexcision" means additional surgery in the same area.

Current health care reforms that are taking place in the USA call for more doctor and hospital transparency and accountability of patient outcomes.

The authors wrote:

"Breast-conserving therapy, or partial mastectomy, is one of the most commonly performed cancer operations in the United States. Currently, there are no readily identifiable quality measures that allow for meaningful comparisons of breast cancer surgical outcomes among treating surgeons and hospitals."

A surgeon's aim when performing a mastectomy is to achieve adequate surgical margins - there should be a rim of normal tissue around the excised tumor so that there is no cancerous tissue left behind. Additionally, the cosmetic appearance of the breast should be maintained as much as possible.

If clear margins are not achieved after the initial surgery, further surgical intervention will be required. Additional operations cause significant physical, emotional, mental and economic stress for patients, and also delay vital supplemental therapies.

The authors wrote:

"Thus, the effect of reexcision on altering a patient's initial treatment of choice is significant."

Laurence E. McCahill, M.D., and team set out to measure what the reexcision rates are across surgeons and hospitals in the USA that treat patients with comparable clinical conditions. They specifically looked at female patients with invasive breast cancer who underwent partial mastectomy across 4 institutions and 3 large health plans. They gathered data from various sources, including electronic medical records, outpatient records, and pathology archives.

Out of 2,206 women in their study, 2,220 had been recently diagnosed with invasive breast cancer and had breast-conserving surgery performed on them. Their average age was 62 years. 92.8% of them were non-Hispanic white.

Below are some highlighted findings from this study:22.9% (509) had additional surgery on the affected breast89.2% of those who had additional surgery underwent a single reexcision9.4% (48) of the additional surgery patients underwent 2 reexcisions1.4% (7) underwent 3 reexcisions8.5% (190) of them had a total mastectomyThe researchers wrote:

"Reexcision rates for margin status following initial surgery were 85.9 percent for initial positive margins