Removing more breast tissue during surgery reduces costs

A 10-minute procedure to remove a little more tissue during a partial mastectomy could spare thousands of breast cancer patients a second surgery but and also cut costs by as much as $750 per patient, according to a Yale Cancer Center study.

The findings are scheduled for presentation Dec. 10 at the 2015 Annual San Antonio Breast Cancer Symposium.

Nearly 300,000 women in the United States are diagnosed with breast cancer each year; more than half undergo breast-conserving surgery with a partial mastectomy to remove the disease. About a third of patients who undergo this procedure have "positive margins," or cancer cells found at the edge of the removed tissue, and will require a second surgery to ensure that no cancer remains. A Yale study, published online in May in the New England Journal of Medicine, demonstrated that removing more tissue all the way around the tumor site during the initial surgery—known as cavity shave margins (CSM)—could cut the need for a second surgery in half. 

Given these data, the Yale investigators explored how this technique, which adds only 10 minutes to the operation time, would affect costs.

"At a time when healthcare costs are skyrocketing, and patients face significant financial burden with their treatments, it's increasingly important to look at value in cancer care," said first author Dr. Anees Chagpar, associate professor of surgery (oncology) at Yale School of Medicine and director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven. "We found that taking cavity shave margins resulted in fewer return trips to the operating room at no added cost. Clearly, this is a win all around—for patients, providers, and payers."

The Yale study prompted discussion among surgeons around the world about the benefits of CSM. This technique has now been incorporated into some professional organizations' guidelines, and a multi-center study to validate the Yale findings is set to start in 2016.