When Breast-Conserving Surgery Doesn't Work the First Time

Abstract and Introduction

Abstract

In England, one in five women with breast cancer who had breast-conserving surgery required reoperation.

Introduction

For women with invasive breast cancer, breast-conserving surgery plus radiotherapy yields survival rates similar to those achieved with mastectomy alone. However, breast-conserving surgery necessitates reoperation if the malignancy has been excised inadequately — and reoperation can lead to emotional distress, delays in adjuvant treatment, higher costs, and poorer cosmetic outcomes. Investigators in England analyzed national data to determine likelihood of, and factors associated with, reoperation after breast-conserving surgery.

Of 96,000 women who underwent primary breast cancer surgery, 55,000 underwent breast-conserving surgery. Of these, 83% had invasive disease, 12% had in situ disease, and 5% had both. Within 3 months after breast-conserving surgery, 11,000 women (20%) underwent reoperation (either additional breast-conserving surgery or mastectomy). Women with carcinoma in situ were significantly more likely to require reoperation than were women without in situ disease (30% vs. 18%). Reoperation also was significantly more likely in women younger than 50 than in older women.