Breast-Conserving Surgery May Lead to Reoperation, Increased Costs

Breast-conserving surgery could lead to higher reoperation rates and greater insurance costs.

In patients with breast cancer who received breast-conserving surgery, rates of operation after previous operation have remained high, which has contributed toward an increase in health care costs, according to a recent study published in Annals of Surgical Oncology.

For patients with breast cancer, it’s important to note that reoperation rates — which could happen when some cancer cells remain after surgery — may be higher than expected after breast-conserving surgery, researchers found.

Additionally, the researchers emphasized that patients who received chemotherapy before surgery or received oncoplastic surgery immediately had lower reoperation rates.

Breast-conserving surgery is defined as a procedure to remove cancer or any abnormal tissue from the breast, along with some normal tissue surrounding it, according to the National Cancer Institute. This procedure, however, does not remove the entire breast.

Researchers included 17,129 women with a median age of 55 in one cohort, all of whom had commercial insurance. The second cohort included 6,977 women with a median age of 73, all of whom had Medicare.

Among all of the patients in the study, the researchers established that reoperation rates (the percentage of patients who underwent more than one operation after initial breast-conserving surgery) were 21.1% for patients with commercial insurance and 14.9% for patients with Medicare.

Researchers also found that as patient age increased, the reoperation rates decreased.

Overall, reoperations were associated with a 24% higher cost for patients, regardless of whether they had commercial insurance or Medicare. Specifically, researchers noted that incremental costs would be $21,607 for patients with commercial insurance and $8,559 for patients with Medicare.

READ MORE: One-Third of Patients Skip Local Hospital for Breast Cancer Surgery

In terms of health care costs, patients in the commercial cohort had health care costs of $95,165 during one year of follow-up from initial breast-conserving surgery. Health care costs for patients in the Medicare cohort were $36,313, according to the study.

The study found that patients with ductal carcinoma in situ (DCIS) had higher rates of reoperation, compared with patients with other types of breast cancer.

According to the American Cancer Society, DCIS is when cancer cells have lined the milk ducts of the breast, but do not spread to the surrounding breast tissue. This form of breast cancer is not invasive, although leaving it untreated may lead to some abnormal changes that could become invasive breast cancer.

“Women who were younger with DCIS had a much higher risk for reoperation,” explained a study author. “We found that women aged 18 to 44 with DCIS in the commercial cohort had a 40% [risk for reoperation].”

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