Researchers from Michigan State University reported in the JAMA (Journal of the American Medical Association) have conducted a new study that found that 22.9% of breast cancer patients who undergo partial mastectomies eventually need additional operations to remove more tissue. The authors noted that rates of reexcision (additional surgeries) differ widely between surgeons and hospitals, and that the variations do not seem to be caused by the patients' clinical characteristics. As recent health care reforms in the USA have called for more doctor and hospital transparency and accountability, the Michigan State study shows the need for more research to determine the association between initial surgical care and long-term patient outcomes when it comes to breast cancer.
In order to conduct the study, the researchers examined the reexcision rates for surgeons and hospitals treating at female patients with invasive breast cancer who underwent partial mastectomy. The study used data from 4 institutions and 3 large health plans, including all electronic medical records, outpatient records, and pathology archives. Of the 2,220 women in their study, 2,206 had recent breast-conserving surgery. The average age of the women in the group was 62 years and nearly all of them (92%) were non-Hispanic white. In the group of 509 women (22.9%) who experienced additional surgery on an affected breast, 89% underwent a single reexcision and 9.4% had 2 reexcisions. Only 1.4% of the women had to have 3 surgeries, while an additional 8.5% had total mastectomies.
The study’s authors found that although breast-conserving, partial mastectomies are the most commonly performed cancer operations in the United States, there are no useable measures of quality to make comparisons of the surgical outcomes among the different surgeons and hospitals.
Because a surgeon's goal when performing a mastectomy is to both to excise the tumors and still preserve the cosmetic appearance of the breast as much as is possible, additional operations can cause physical, emotional, mental and economic stress for patients, and also delay the use of beneficial supplemental therapies.
The study showed that for patients with no cancer cells remaining at the outer edge of the tissue that was removed, the reexcision rates varied for both surgeons and hospitals. For those patients who did have cancer cells remaining at the outer edge of the tissue that was removed, the reexcision rates ranged from 73.7% to 93.5%. The numbers caused the researchers to conclude that differences in surgeons' training along with variations in how surgical data is interpreted in different regions of the country may be the root cause of the widely varied reexcision rates. The study’s authors concluded that since both the recurrence of tumor growth and the overall chances of patient survival are affected by variability in initial surgical care, the variation can be a barrier to effective care of patients with breast cancer.
