More Surgery Often Needed After Lumpectomy

If the tumor is small enough and it's early stage breast cancer, most women elect to have breast conserving surgery, popularly called lumpectomy. New research suggests this choice can lead to more surgeries. At least in England.

For every five women in England who have a lumpectomy, one woman will have to have another operation to achieve "negative margins" containing no cancer cells.

Ask your surgeon about the likelihood of additional surgeries.

Patrick Maguire, MD, a radiation oncologist in North Carolina, told dailyRx that 20 percent is on "the high end of what I would expect, but not unreasonable."

This retrospective (looking at the past) study evaluated hospital statistics relating to 55,297 women from throughout England between 2005 and 2008.

Researchers from around England relied on the national Hospital Episode Statistics (HES) database for this analysis.

Most of the women (82 percent) had invasive breast cancer isolated to one tumor; 12 percent of the women were diagnosed with carcinoma in-situ, which is considered a pre-cancerous condition, and 6 percent of the women had both invasive and in-situ cancers.

Researchers looked at how often women had to have follow-up surgeries and adjusted the rates for age, tumor type, other health issues and socioeconomic status.

Nearly 30 percent of women with carcinoma in-situ required another operation, compared to 18 percent of women who had isolated invasive disease.

When re-operations were necessary, 40 percent of the women had mastectomies.

Researchers found other trends. Additional operations were lower in older women, those with other health conditions (co-morbidities) and women from poorer areas of the country.

Additional study is needed to fully explain these rates. The authors said that these findings should alert women to learn what the re-operation rate is for her surgeon and the facility in which she's being treated.

Dr. Maguire talked about the statistics for this country. "Depending upon the surgeon's practice of how to obtain 'negative margins' and pathologist's evaluation of such, these re-operation rates can range from single digits to 25-30 percent."

The author of When Cancer Hits Home: An Empowered Patient is the Best Weapon Against Cancer continued. "Most surgeons rightly inform their patients prior to surgery of very real possibility of requiring second operation to obtain negative margins (adequate breast conserving surgery). Most women are willing to accept this risk for the high likelihood that they will keep their breast," Dr. Maguire said.

This research was published in July in BMJ (British Medical Journal).

The work was supported by an award from the Department of Health and National Health Service. No competing interests were reported.