Research: Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics
One in five women with breast cancer who opt for breast conserving surgery rather than a mastectomy have a reoperation, according to a national study published on bmj.com today. This information on the risk of reoperation should help women in making the decision about whether to undergo breast conserving surgery or mastectomy.
45,000 women are diagnosed with breast cancer each year in England and in 2008, 58% chose to have part of the breast removed (breast conserving surgery) rather than the whole breast (mastectomy).
When combined with radiotherapy, breast conserving surgery produces similar survival rates to those achieved with mastectomy alone. But because some tumours are difficult to detect, breast conserving surgery may result in their inadequate removal and lead to another operation. This reoperation may involve another breast conserving operation or a mastectomy.
Few studies have examined breast conserving surgery reoperation rates and there is uncertainty about how likely women are to require one. So researchers from around the UK looked at data collected from the Hospital Episode Statistics (HES) database on 55,297 women with breast cancer who underwent breast conserving surgery in the NHS between 2005 and 2008. All women were aged 16 or over.
Rates of reoperation were looked at after three months following the first breast conserving surgery. Rates were adjusted for tumour type, age, co-morbidity and socio-economic deprivation.
Out of the 55,297 women who underwent breast conserving surgery, 45,793 (82%) were suffering from isolated invasive cancer, 6622 (12%) had isolated carcinoma in-situ (pre-cancerous disease), and 2882 (6%) had both invasive and in-situ disease. Reoperation was more likely among women with carcinoma in-situ disease (29.5%) compared to those with isolated invasive disease (18%). Around 40% of women who had a reoperation underwent a mastectomy.
Further results suggest that reoperation is less likely in older women and in those with more co-morbid conditions. Reoperation was also marginally lower in women from more deprived areas.
Reoperation rates also varied substantially between NHS trusts, but the authors stress that further research is required to understand its cause. It may partly reflect patient preferences for alternative treatment options. However, they say it does highlight the importance of women being made aware of local reoperation rates following primary breast conserving surgery.
In conclusion, half of women diagnosed with breast cancer in England now opt for breast conserving surgery but one in five have a reoperation. This increases to one in three of those women who have carcinoma in-situ disease.
