1 in 4 Women Having a Lumpectomy Will Need a Second Surgery

Lumpectomy
Lumpectomy. Photo @ ADAM

In a study that appears in the online edition of the journal JAMA Surgery, researchers found that 1 in 4 women having a lumpectomy will need a follow-up surgery within 90 days. The study was undertaken to assess the incidence of second surgeries, and the effect a surgeon’s experience had on the need for a second surgery.

The findings in this study are not only important for women currently facing breast cancer surgery, but for every woman who needs and wants to be educated about her surgical choices should she be diagnosed with breast cancer in the future.

A woman needs to choose surgical procedures knowing full-well what each surgery entails, the possible side-effects initially, and long term, and the chance that additional surgery may be required to successfully remove her breast cancer.

A lumpectomy, which is breast-conserving surgery, is the usual surgical recommendation for women with early-stage breast cancer. A lumpectomy followed by radiation therapy has proven to be as effective as a mastectomy for treating early breast cancer. Surgical recovery time is shorter, and a woman still has her natural breast. There is also the option to have reconstruction to restore breast symmetry.

During a lumpectomy, the surgeon removes the breast tumor and an area of surrounding tissue. This area is referred to as a margin, which is actually what appears to be a rim of normal tissue around the tumor. If the margin of tissue is found to contain cancer cells when examined by a pathologist following the surgery, a second surgery will be necessary.

The additional surgery is done to prevent a local recurrence of the breast cancer.

The study examined the records of close to 90,000 women having had a lumpectomy in New York State from January 1, 2003, to December 31, 2013. The study looked at the records from all hospitals and ambulatory surgery centers in New York State.

Findings:

  • Use of lumpectomy has declined, especially among younger women.
  • During the study years, the rate of re-operation that occurred within 90 days of an initial lumpectomy was not quite 31 %. That is down from 40% several years ago.
  • The rates of re-operation were highest among women between 20 and 49 years old and lowest in those women 65+years and older.
  • Re-operation rates following lumpectomies varied significantly from surgeon to surgeon. Those surgeons who perform more than 34 lumpectomies per year had a lower risk for a re-operation.
  • Re-operation rates go down when there are well-trained breast surgeons, and a team approach to care.
  • Although the study took place in New York State, it has ramifications for other states across the country.
  • Knowing how often women need to have a repeat surgery following a lumpectomy is important to surgeons because they need to find ways that they can to help reduce the risk for each woman.
  • Every woman is entitled to know her risk of needing a re-operation if she chooses a lumpectomy. She needs to have this information so she can make an informed decision.  

    What This Study Means for You

    Having had a lumpectomy for my first breast cancer, I can share that when my surgeon recommended a lumpectomy, I didn’t even know the questions to ask. He explained the procedure, but not the possibility of my needing additional surgery if he did not make his margins. The first time I heard the word margins was when my surgeon called me with the results of my pathology report. He said, “I made my margins; you will not need any additional surgery.”

    I can’t imagine how frightened and angry I would have been had I needed additional surgery and hadn’t been prepared for that possibility beforehand. I was fortunate; I know many women who needed a second surgery. The additional anxiety of a second surgery made healing a much longer process.

    It is important for every woman, newly diagnosed with breast cancer, to understand her options for surgery. Every aspect of the surgery, be it lumpectomy, mastectomy or bilateral mastectomy needs to be explored at a time when fear and uncertainty can cloud judgement and make decision-making extremely difficult.That is why bringing a friend or family member to the first meeting with the breast surgeon is critical. This person’s role needs to be clear:

    • Prior to the surgeon visit, help the patient put a list together of questions to ask the surgeon.
    • At the visit, remind the patient of any questions she forgot to ask.

    This study points out that while many women may still need an additional surgery following a lumpectomy, there is a way to reduce the chances of needing a second surgery. It is important to choose a surgeon who performs this surgery frequently. Cancer centers and major medical centers have surgeons who perform lumpectomies on a regular basis.

    Source:

    JAMA Surgery. 2016 February 17: Repeat Surgery After Breast Conservation for the Treatment of Stage 0 to II Breast Carcinoma A Report From the National Cancer Data Base, 2004-2010.

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