A recent study published in the Annals of Surgical Oncology, has brought attention to a concerning trend in the treatment of breast cancer, specifically regarding breast-conserving surgery.
This type of surgery aims to remove cancerous tissue while preserving as much of the breast as possible. However, it’s been found that a significant number of patients need to undergo additional surgeries due to the presence of cancer cells at the surgical margins, even after initial treatment.
This issue persists despite guidelines established in 2014 aimed at reducing such instances.
The research conducted by Kim et al. involved examining data from over 24,000 patients, both commercially insured and Medicare beneficiaries, who underwent breast-conserving surgery between 2017 and 2019. The findings revealed that more than 20% of commercially insured patients and nearly 15% of Medicare beneficiaries had to undergo reoperations within a year after their first surgery.
These reoperations not only lead to a 24% increase in healthcare costs, adding thousands of dollars in expenses for both groups, but also significantly heightened the risk of postoperative complications—54% for commercially insured patients and 89% for Medicare beneficiaries.
Several factors were identified that could affect the likelihood of needing a reoperation, such as younger age and the presence of ductal carcinoma in situ. On the other hand, the use of neoadjuvant chemotherapy and immediate oncoplastic surgery were linked to a lower risk of requiring additional surgeries.
The study underscores a critical issue in breast cancer care—despite existing guidelines and advancements in treatment, high rates of reoperation remain, leading to increased healthcare costs and a greater risk of complications.
The authors argue for better intraoperative assessments to minimize the need for further surgeries and enhance the overall quality of breast cancer treatment.
“Accounting for instances in which extent of disease might be underestimated on the imaging findings and other such factors that may lead to a positive margin on final pathology, ideally, the reoperation rates should be closer to 5%,” said co–author Dr. Nina Tamirisa, MD, Assistant Professor in the Department of Breast Surgical Oncology at The University of Texas MD Anderson Cancer Center.
“Improvements in the intraoperative assessment of margins should be utilized to mitigate the risk of additional surgery and improve delivery of breast cancer care,” she explained.