In the Journals

One-fifth of breast-conserving surgeries in England required reoperation

One in five women with breast cancer who opt for breast-conserving surgery has a reoperation within 3 months, according to results of a national study.

Breast-conserving surgery involves removing part of the affected breast. When combined with postoperative radiotherapy, it produces comparable survival rates to mastectomy, according to researchers.

In England, about 45,000 women are diagnosed with breast cancer annually. In 2008, 58% chose breast-conserving surgery. The selection of breast-conserving surgery is generally based upon the extent of the cancer, size of the tumor relative to the size of the breast, location and patient preference, according to researchers.

In the study, Ranjeet Jeevan, MRCS, a research fellow in the clinical effectiveness unit at the Royal College of Surgeons of England, and colleagues examined data from 55,297 women aged at least 16 years with breast cancer who underwent breast-conserving surgery from April 1, 2005, to March 31, 2008. Jeevan and researchers collected data from the Hospital Episode Statistics database, which contains records of patients admitted to NHS trusts in England.

Rates of reoperation were examined 3 months after the first breast-conserving surgery and were adjusted for tumor type, age, comorbidity and socioeconomic deprivation.

Of the women who underwent breast-conserving surgery, 45,793 (82%) had isolated invasive disease, 6,622 (12%) had isolated precancerous carcinoma and 2,882 (5.2%) had invasive and precancerous carcinoma. Eighteen percent of those with isolated invasive disease had at least one reoperation vs. 29.5% of the women with precancerous carcinoma, the researchers said.

In the 3 months after primary breast-conserving surgery, 11,032 (20%) women had at least one reoperation, and 10,212 had one reoperation only — either a mastectomy (4,269) or further breast-conserving surgery (5,943). The remaining 820 (1.5%) women had two or more reoperations.

Reoperation was less likely in older women and those with comorbid conditions, according to study results.

Adjusted reoperation rates for the 10th centile (12.2%) and 90th centile (30.2%) varied substantially among individual NHS trusts, according to researchers.

“The current situation is unsatisfactory as it results in women having experiences of care that depend on where they are treated,” Jeevan and colleagues wrote in the study. “This is of concern because around 40% of women who had a reoperation after breast conserving surgery ended up having a mastectomy. The reasons for the lower rates of reoperation at particular NHS trusts should be explored so that lessons can be learned and disseminated.”

More than half of the women diagnosed with breast cancer in England select breast-conserving surgery. These patients should be made aware of the rates of reoperation along with the likelihood of additional surgical treatments such as mastectomy, Jeevan and colleagues said.

“In addition, breast cancer teams should do a local review of surgical technique, the definition of an adequate excision margin, imaging methods and criteria for selecting patients,” the researchers concluded. “This may lead to an overall reduction in the reoperation rate after [breast-conserving surgery].”

Disclosure: Mr. Jeevan reports no relevant financial disclosures.

One in five women with breast cancer who opt for breast-conserving surgery has a reoperation within 3 months, according to results of a national study.

Breast-conserving surgery involves removing part of the affected breast. When combined with postoperative radiotherapy, it produces comparable survival rates to mastectomy, according to researchers.

In England, about 45,000 women are diagnosed with breast cancer annually. In 2008, 58% chose breast-conserving surgery. The selection of breast-conserving surgery is generally based upon the extent of the cancer, size of the tumor relative to the size of the breast, location and patient preference, according to researchers.

In the study, Ranjeet Jeevan, MRCS, a research fellow in the clinical effectiveness unit at the Royal College of Surgeons of England, and colleagues examined data from 55,297 women aged at least 16 years with breast cancer who underwent breast-conserving surgery from April 1, 2005, to March 31, 2008. Jeevan and researchers collected data from the Hospital Episode Statistics database, which contains records of patients admitted to NHS trusts in England.

Rates of reoperation were examined 3 months after the first breast-conserving surgery and were adjusted for tumor type, age, comorbidity and socioeconomic deprivation.

Of the women who underwent breast-conserving surgery, 45,793 (82%) had isolated invasive disease, 6,622 (12%) had isolated precancerous carcinoma and 2,882 (5.2%) had invasive and precancerous carcinoma. Eighteen percent of those with isolated invasive disease had at least one reoperation vs. 29.5% of the women with precancerous carcinoma, the researchers said.

In the 3 months after primary breast-conserving surgery, 11,032 (20%) women had at least one reoperation, and 10,212 had one reoperation only — either a mastectomy (4,269) or further breast-conserving surgery (5,943). The remaining 820 (1.5%) women had two or more reoperations.

Reoperation was less likely in older women and those with comorbid conditions, according to study results.

Adjusted reoperation rates for the 10th centile (12.2%) and 90th centile (30.2%) varied substantially among individual NHS trusts, according to researchers.

“The current situation is unsatisfactory as it results in women having experiences of care that depend on where they are treated,” Jeevan and colleagues wrote in the study. “This is of concern because around 40% of women who had a reoperation after breast conserving surgery ended up having a mastectomy. The reasons for the lower rates of reoperation at particular NHS trusts should be explored so that lessons can be learned and disseminated.”

More than half of the women diagnosed with breast cancer in England select breast-conserving surgery. These patients should be made aware of the rates of reoperation along with the likelihood of additional surgical treatments such as mastectomy, Jeevan and colleagues said.

“In addition, breast cancer teams should do a local review of surgical technique, the definition of an adequate excision margin, imaging methods and criteria for selecting patients,” the researchers concluded. “This may lead to an overall reduction in the reoperation rate after [breast-conserving surgery].”

Disclosure: Mr. Jeevan reports no relevant financial disclosures.