Breast conserving surgery may not be so "conserving"

• Large cohort study looks at reoperation within 3 months of conservative procedure

• Mastectomy reported in 40% of women who had second surgery

About 1 in every 5 women (18%) who receives breast-conserving surgery for breast cancer receives a second operation within 3 months. And reoperation is almost twice as likely (29%) in those with carcinoma in situ (CIS). Furthermore, 1 in 7 women who choose breast-conserving surgery as their reoperation require additional surgery.

The findings, published in the British Medical Journal, come from a cohort study conducted in England involving more than 55,000 adult women who received primary breast conserving surgery between April 2005 and March 2008. The investigators used a comprehensive national database to reduce risk of selection bias.

Of all the women, 82% had isolated invasive cancer and 18% needed a second operation within 3 months. Twelve percent of the women had isolated CIS identified at the time of the first surgery, 29.5% of whom needed a second operation within 3 months of the first procedure. The remaining 6% of the women had both types of cancer. Ultimately, 40% of the women who had a reoperation after breast conserving surgery ended up having a mastectomy.

One of the strengths of the study, according to its authors, is that the timeframe for inclusion of reoperation (that is, 3 months) is long enough to exclude procedures performed for complications of the first surgery and short enough to exclude procedures performed for early local recurrence.

The researchers say that their results underscore the need, when reviewing treatment choices with patients, to discuss not only survival benefits but also rates of reoperation and likelihood of an ultimate mastectomy. They also emphasize the importance of offering mastectomy with immediate reconstruction as a primary treatment option.

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