Breast-conserving surgery leads to further operations
Posted Jul 17 2012 7:15am
A study of over 50 thousand women in England has found that around half of women undergoing breast-conserving surgery for either isolated invasive breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. or isolated ductal carcinoma in situ (DCIS)A type of non-invasive breast cancer arising in a milk duct, also known as intraduct carcinoma went on to have further surgery. The majority of women in England (58%) suffering from breast cancer undergo breast-conserving surgery, also known as lumpectomy, to prevent the removal of the whole breast by removing just the tumourAn abnormal swelling. and some surrounding tissueA group of cells with a similar structure and a specialised function..
This new report, conducted by the London School of Hygiene and Tropical Medicine and published in the British Medical Journal discovered that women with DCIS had a one in three chance of the cancer recurring with the need for a further operation. This is due to the difficulty in identifying tumours in this pre-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. form of breast disease. The authors emphasised, however, that breast-conserving surgery is as effective as mastectomy when combined with radiotherapyThe treatment of disease using radiation. and that older women are less likely to require, or want, a repeat operation.
Forty per cent of follow-up breast operations carried out between 2005 and 2008 involved the removal of the whole breast (mastectomy). Many women who have follow-up surgery will also require subsequent reconstructive surgery.
Leading Consultant Breast Surgeon and totalhealth contributor, Professor Kefah Mokbel , comments on the survey as follows:
The study has examined the re-operation rate within the three months following breast conserving surgery for breast cancer. It is well-recognised that a certain proportion of women who opt to have breast conserving surgery for breast cancer will require further surgical procedures depending upon the final pathology analysis. Therefore, this study does not add anything new regarding this and its results are consistent with other published studies. The main limitations of this study include the use of data based on the codes of procedures by NHS hospitals and this approach is known to be inaccurate. However, the most interesting aspect of this study is the significant variation in the re-operation rate from one NHS hospital to another and this may reflect the lack of consensus regarding what represents adequate surgical margins for cancer. Therefore, I agree with the authors that there is a need for a national consensus regarding this matter. However, the authors have not looked at the grade of the operating surgeon, which is likely to be a very significant factor contributing to the re-operation rate. Many patients undergoing breast cancer surgery in the NHS are operated on by trainees, and the limited experience of these trainee surgeons is known to be associated with a higher incidenceThe number of new episodes of a condition arising in a certain group of people over a specified period of time. of positive surgical margins and the need for further surgery.
Caution should be exercised when interpreting the results of this study since globally, the trend is towards carrying out more limited surgery and conserving healthy breast tissue. The use of modern imaging modalities, such as MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. in selected cases, in addition to accurate intra-operative assessment regarding the adequacy of the surgical margins by the operating surgeon ensure that the incidence of re-operation following breast conserving surgery is minimised. It is important to ensure that patients are operated on by experienced breast cancer surgeons and that a proper pre-operative multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. discussion takes place.