Study Finds Decreased Use of Primary Breast-Conserving Surgery for Women in New York State
In a study reported in JAMA Surgery, Isaacs et al found that use of primary breast-conserving surgery for early-stage breast cancer has declined somewhat in recent years in New York State, most steeply among younger women. In addition, 90-day reoperation rates have declined and are lower for high-volume surgeons.
Study Details
The study involved a population-based sample of 89,448 women aged ≥ 20 years undergoing primary breast-conserving surgery from January 2003 to December 2013 in New York State mandatory reporting databases, including patients from all hospitals and ambulatory surgery centers in New York State. Patents had a mean age of 62 years.
Numbers of Women
In 2013, 1,416 women between the ages of 20 and 49, 3,068 between the ages of 50 and 64, and 3,644 aged ≥ 65 years underwent breast-conserving surgery, representing a significant numeric decrease (P < .001 for trend) from the 1,960 women < 50 years but little difference from the 2,899 women between the ages of 50 to 64 and the 3,270 aged ≥ 65 years who underwent breast-conserving surgery in 2003.
Reoperation Rates
The mean overall rate of 90-day reoperation was 30.9%, decreasing from 39.5% (6,630 of 16,805) in 2003–2004 to 23.1% (5,148 of 22,286 patients) in 2011–2013. Reoperation rates were highest in women between the ages of 20 and 49 (37.7%; 6,990 of 18,524) and lowest in women ≥ 65 years (26.3%; 9,656 of 36,691; P < .001 for trend). Rates of 90-day reoperation ranged from 35.2% for low-volume surgeons (< 14 cases per year), 29.6% for middle-volume surgeons (14–33 cases per year), and 27.5% for high-volume surgeons (> 34 cases per year). In an adjusted analysis, odds ratios were 1.49 (95% confidence interval [CI] = 1.19–1.87) for low-volume and 1.20 (95% CI = 0.93–1.56) for middle-volume surgeons vs high-volume surgeons.
Use of breast-conserving surgery as a subsequent procedure increased from 63.9% (4,237 of 6,630) in 2003–2004 to 82.7% (4,258 of 5,148) in 2011–2013 (P < .001 for trend). Among all 19,466 women undergoing breast-conserving surgery as a second procedure, 2,429 (12.5%) required a third intervention (2.7% of all women).
The investigators concluded: “Use of breast-conserving surgery has decreased overall, most steeply in younger women. Nearly 1 in 4 women underwent a reoperation within 90 days of breast-conserving surgery across New York State from 2011 to 2013, compared with 2 in 5 from 2003 to 2004. Rates vary significantly by surgeon, and initial breast-conserving surgery performed by high-volume surgeons was associated with a 33% lower risk for a reoperation.”
Art Sedrakyan, MD, PhD, of Weill Cornell Medical College, is the corresponding author of the JAMA Surgery article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
