Investigators have uncovered high rates of reoperation following initial breast-conserving surgery in patients with breast cancer that may contribute to increased costs of cancer care and a higher risk of postoperative complications, according to a recent study published by Kim et al in the Annals of Surgical Oncology.
Background
Breast cancer is the second most common cancer type in women and accounts for about 33% of new cancer diagnoses in women in the United States. Breast-conserving surgery—a procedure designed to remove cancerous tissue along with a surrounding margin of healthy tissue—is typically recommended in patients with breast cancer to preserve as much of the breast as possible. However, if cancer cells persist at the surgical margins, additional operations may be required. Despite consensus guidelines released in 2014 by the Society of Surgical Oncology–American Society for Radiation Oncology on surgical margins for breast-conserving surgery, the investigators have highlighted a high rate of reoperation.
“Previous studies reported a significant decrease in reoperation rates immediately after the publication of the guidelines, but there was no evidence of further reduction observed in subsequent years. The purpose of this study was to provide a more comprehensive and current understanding of reoperation rates and health-care costs associated with reoperation for patients who underwent breast-conserving surgery at the population level,” explained emphasized lead study author Youngran Kim, PhD, Assistant Professor at the Center for Health Care Data in the Department of Management, Policy, and Community Health at the UTHealth Houston School of Public Health.
Study Methods and Results
In the recent study, the investigators identified 17,129 commercially insured patients aged 18 to 64 years and 6,977 Medicare beneficiaries aged 18 years and older who underwent initial breast-conserving surgery between 2017 and 2019. After A follow-up of 1 year, the investigators discovered that the reoperation rates among the commercially insured patients and Medicare beneficiaries were 21.1% and 14.9%, respectively.
These reoperations correlated with a 24% increase in costs for both the commercial insured and Medicare groups, translating into incremental expenses of $21,607 and $8,559, respectively. The investigators noted that the reoperations were also linked to a respective 54% and 89% increased risk of postoperative complications in the commercially insured patients and Medicare beneficiaries. The investigators reported that younger age and ductal carcinoma in situ were associated with a higher rate of reoperation, whereas the use of neoadjuvant chemotherapy and immediate oncoplastic surgery were associated with a lower rate of reoperation.
Conclusions
“Using commercial insurance claims and Medicare data, the study has unveiled critical insights into reoperation rates and associated health-care costs for patients undergoing breast-conserving surgery. After undergoing initial breast-conserving surgery, one in five commercially insured women and one in seven enrolled in Medicare experienced reoperation, according to our research,” stressed Dr. Kim. “Our findings underscore the persistence of high reoperation rates after breast-conserving surgery, contributing significantly to increased health-care costs and adverse outcomes,” she added.
“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%,” emphasized co–study author 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 concluded.
Disclosure: The research in this study was funded in part by a gift from Perimeter Medical Imaging. For full disclosures of the study authors, visit link.springer.com.
