Breast Reexcision Rates Vary With Surgeon, Institution

For women who undergo partial mastectomy and have negative margins, significant variation seen

TUESDAY, Jan. 31 (HealthDay News) -- For women with invasive breast cancer who undergo partial mastectomy and have negative margins, reexcision rates vary substantially depending on the surgeon and institution, according to a retrospective chart review published in the Feb. 1 issue of the Journal of the American Medical Association.

Laurence E. McCahill, M.D., from Michigan State University in Grand Rapids, and colleagues evaluated hospital-specific and surgeon-specific variation in reexcision rates following partial mastectomy for 2,206 women with 2,220 invasive breast cancers, performed at four institutions between 2003 and 2008. Data were collected from electronic medical records, chart abstraction, and outpatient records.

The investigators found that 22.9 percent of women underwent reexcision (89.2, 9.4, and 1.4 percent underwent one, two, and three reexcisions, respectively). Of all those who underwent initial partial mastectomy, 8.5 percent underwent total mastectomy. For women with initial positive margins following partial mastectomy, the reexcision rate was 85.9 percent; the reexcision rates were 47.9 percent for less than 1.0 mm margins, 20.2 percent for 1.0 to 1.9 mm margins, and 6.3 percent for 2.0 to 2.9 mm margins. Reexcision rates varied widely among surgeons (0 to 70 percent; P = 0.003) and institutions (1.7 to 20.9 percent; P < 0.001) for patients with negative margins. After adjusting for case mix, there was no association between reexcision rates and surgeon procedure volume.

"We found individual surgeons and institutions were associated with variation in reexcision rates following initial partial mastectomy for invasive breast cancer. This variability cannot be explained entirely by patients' clinical factors," the authors write.

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