About 20% of Women Need More Surgery After Lumpectomy

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A British study has found that about 20% of women who have lumpectomy (also called breast conserving surgery or partial mastectomy) have to have more surgery once their doctors have all the information about the cancer and breast tissue that was removed.

The results were published July 12, 2012 in the British Medical Journal  (BMJ). Read “Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics.”

These new results are very similar to the results of a U.S. study on the need for more surgery after lumpectomy that were published in February 2012 in the Journal of the American Medical Association.

Lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk was about the same with either type of surgery.

During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue (called the margin) that is around it. After lumpectomy, a pathologist carefully examines the tissue that was removed to see if cancer cells are in the margins. Margins that have no cancer are called “negative” or “clean.” Margins that have cancer cells are called “positive.”

In a perfect world, your surgeon would learn the status of the margins before the lumpectomy is completed, so as much tissue as needed can be removed until the margins are clean. Unfortunately, analyzing the removed tissue takes about a week. Sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery is needed. This additional surgery is called a re-excision lumpectomy.

Because all the breast tissue is removed during a mastectomy, there’s usually no need for more surgery.

The researchers looked at the records of 55,297 British women who were diagnosed with early-stage invasive breast cancer (45,793 women) or DCIS (9,504 women) and had lumpectomy between 2005 and 2008.

DCIS -- ductal carcinoma in situ -- is non-invasive breast cancer that hasn’t spread beyond the milk duct where it started.

In the 3 years after lumpectomy, 11,032 (20%) of the women needed at least one more operation.

About 18.5% (10,212 women) had only one additional operation:

  • 5,943 women had another lumpectomy
  • 4,269 women had a mastectomy

About 1.5% of the women (820 women) had two or more additional operations.

The researchers also looked to see if the type of breast cancer made a difference in the likelihood that a woman would need more surgery:

  • 8,229 women (18%) diagnosed with invasive breast cancer had at least one more operation
  • 2,803 women (29.5%) diagnosed with DCIS had at least one more operation

This means that women diagnosed with DCIS were more than twice as likely to need more surgery after lumpectomy than women diagnosed with invasive breast cancer.

If you’ve been diagnosed with early-stage invasive breast cancer or DCIS and are planning your treatment, you and your doctor will consider which type of surgery makes the most sense for you based on your unique situation. For many women, lumpectomy followed by radiation therapy is a good option and more attractive than mastectomy, both physically and emotionally.

Still, choosing lumpectomy means possible repeat surgery after the lumpectomy tissue removed is analyzed, especially if you’ve been diagnosed with DCIS. Talk to your doctor about any concerns you have about this possibility and how your concerns might influence the type of surgery you choose. Together, you and your doctor can decide on a surgical plan that is right for YOU.

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