Researchers find rate of follow-up surgeries after partial mastectomy varies greatly

February 13, 2012 By Jennifer Nachbur

(Medical Xpress) -- A study conducted at the University of Vermont/Fletcher Allen Health Care and three other sites and published in the February 1 issue of the Journal of the American Medical Association found significant variability – by both surgeon and institution – in the rates of follow-up surgeries for women who underwent a partial mastectomy for treatment of breast cancer. The research determined that these differences could not be explained by a patient’s medical or treatment history, and hypothesized that they could affect both cancer recurrence and overall survival rates.

About three-quarters of women battling breast cancer have a partial mastectomy, a surgery that aims to remove cancerous cells while maintaining maximum cosmetic appearance of the breast. However, failure to remove all the cells during the initial operation requires additional surgery. According to the study’s findings, nearly one in four of these women received additional surgery – called reexcision – to remove additional tissue, a situation that can produce considerable psychological, physical and economic stress for patients and delay use of recommended supplemental therapies.

Led by Laurence McCahill, M.D., a former UVM/Fletcher Allen surgeon now at Michigan State University’s College of Human Medicine, the Lacks Cancer Center at Saint Mary’s, and Van Andel Research Institute, the study measured variation in reexcision rates across hospitals and surgeons from 2003 to 2008 in 2,206 women with invasive breast cancer who underwent partial mastectomy at four sites across the country.

In addition to McCahill, collaborators on the study include Richard Single, Ph.D., UVM associate professor of statistics; Ted James, M.D., UVM associate professor of surgery; Johanna Sheehey-Jones, clinical analyst, and John Ratliff, senior measurement analyst, of the Jeffords Institute for Quality and Operational Effectiveness at Fletcher Allen; and researchers from Kaiser Permanente in Colorado, Marshfield Clinic Cancer Care and Research Institute in Wisconsin, and Group Health Research Institute in Washington. This team developed a database of surgical outcomes in order to address these issues. Roughly 1,000 of the women in the study were enrolled at the UVM/Fletcher Allen site.

“A partial mastectomy is one of the most commonly performed cancer operations in the United States,” says McCahill. “Currently, there are no readily identifiable quality measures that allow for meaningful comparisons of breast cancer surgical outcomes among surgeons and hospitals, but the current U.S. health care environment calls for increasing accountability for physicians and hospitals as well as transparency of treatment results.”

“That’s really what this study highlighted – there isn’t a standard of care,” James adds. “This study uncovered a wide variation across the United States in the treatment of women with breast cancer that could potentially impact quality of care. We need to study this further to determine best practices and best outcomes.”

UVM’s Single explains that the size of the study allowed the team to use advanced statistical techniques to model both clinical outcomes variables, as well as individual surgeon-level effects.

“We found that controlling for patient and tumor characteristics, along with the volume of surgeries performed by each surgeon, left a great deal of unexplained variability in the rate of reexcision,” says Single. “For example, given a specific patient, choosing two surgeons at random from different institutions resulted in an average of a 60 percent greater chance of a reexcision for one surgeon versus the other.”

Johanna Sheehey-Jones of Fletcher Allen’s Jeffords Institute for Quality and Operational Effectiveness led the data standardization at all four sites. A uniform data collection instrument was necessary to meaningfully combine data elements extracted from a variety of databases at the participating institutions. John Ratliff, also of the Jeffords Institute, developed the Fletcher Allen databases and aided in the design of the multi-institution database. One of the study’s objectives was to develop an initial framework for identifying areas on which future studies could focus in order to define measures of quality in the surgical treatment for . The current study, says Single, employs comparative effectiveness research, which involves the use of existing data for novel research to improve healthcare delivery and outcomes. Increasing healthcare costs have driven the interest in such research.

Explore further: Study finds substantial variability in rate of additional surgery after partial mastectomy

Related Stories

Study finds substantial variability in rate of additional surgery after partial mastectomy

January 31, 2012
Nearly one in four women who undergo a partial mastectomy for treatment of breast cancer have another surgery to remove additional tissue (reexcision), and there is substantial surgeon and institutional variation in the rate ...

Recommended for you

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.