Study ties lack of specific guidelines to rate of repeat breast cancer surgery

One-fourth of women who have breast-conserving surgery to remove cancer are later told that they need another operation to remove more cancerous tissue, according to a new study in JAMA.

The study also found that the rates of repeat surgery vary widely by physician, suggesting that some operations might be unnecessary or preventable, according to Reuters.

Researchers analyzed data on about 2,200 women undergoing their first breast-conserving surgery—also called a partial mastectomy or lumpectomy—at four hospitals from 2003 through 2008. They found that in 23% of cases, physicians decided that lab reports showed they did not remove enough cells and performed a second operation. In 8% and 9% of all cases, women later had a total mastectomy.

Nearly half of the repeat operations occurred among women whose lab reports showed no remaining cancer cells, which indicates that the patients likely did not benefit from the surgery. Conversely, 14% of patients who did have remaining cancer cells did not have a second operation. The rates of repeat operations varied significantly between surgeons, ranging from zero to 70%, according to the study.

Guidelines unclear
High repeat operation rates are not common with other types of cancer, in part because surgeons are not trying to spare tissue for cosmetic reasons, the authors said. Another reason for the variation is that there is a lack of consensus among surgeons about how much healthy tissue should be removed along with the cancer.

Laurence McCahill—lead author of the study and assistant director of the Lacks Cancer Center—said repeat surgeries are "very hard on patients" from a physical, psychological, and economic standpoint. He suggested developing guidelines to reduce the rate of repeat operations to somewhere between one in 20 and one in five patients.

Monica Morrow—chief of breast surgery at Memorial Sloan-Kettering Cancer Center and author of a commentary published with the study—said second operations are necessary in certain cases because tumors are difficult to spot or feel on first surgery (Pittman, Reuters, 1/31; Grady, New York Times, 1/31).

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