Jan. 31, 2012 -- Close to 1 in 4 breast cancer patients who have partial mastectomies undergo a second surgery to remove suspicious tissue, but there is little agreement about when the second surgery is needed.
Researchers found huge variations from institution to institution and from surgeon to surgeon in the rate of follow-up surgeries women had after breast-conserving surgery.
The study found that some surgeons almost never performed second surgeries while others performed them in 70% of their patients.
Follow-up surgery, known medically as re-excision, is performed when there is a suspicion that the initial surgery left behind cancerous tissue.
This is determined when a post-operative report shows cancer cells at or near the outer margins of the removed breast tissue. When margins are positive, meaning that cancer cells extend to the edge of the tissue, a second surgery to remove more tissue is always needed.
But when the margins are negative, it is less clear which patients will benefit from follow-up surgery.
In the new study, published in the Journal of the American Medical Association, researchers examined re-excision rates at four institutions across the U.S.
Wide Variation From Center to Center
Overall, 454 of the 2,206 breast cancer patients included in the analysis had second surgeries following their initial partial mastectomy. Forty-eight women had two additional surgeries and seven women had three re-excisions.
Second surgeries were performed in 86% of women whose initial tissue margins were positive, but when margins were negative re-excision rates ranged up to 70% among surgeons and from 1.7% to 21% among institutions.
“This study establishes that we have quite a bit of variation in how we deliver care to women who have partial mastectomies,” says researcher Laurence McCahill, MD, who is medical director of surgical oncology at the Lacks Cancer Center and a professor of surgery at Michigan State University.
“This issue has not really been part of the conversation between women and their surgeons, but it needs to be,” he says. “I think people will be surprised to find that almost a quarter of women who have partial mastectomies are going back for more surgery.”