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 after breast-conserving surgery, compared with patients who received a mastectomy, researchers found.
The study findings suggested that opting for a mastectomy may lower the chances of having another operation, while also avoiding some of the expensive health care costs of another surgery. 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.
“The reason [for] having [this increased] price is associated with a higher complication. So that could mean [having an] adverse outcome for [patients],” said Youngran Kim, an assistant professor at UTHealth Houston School of Public Health and first author of the study, during an interview with CURE®.
Researchers also found that as patient age increased, the reoperation rates decreased because the conversion to a mastectomy (removal of the entire breast) was most prevalent among patients who were younger and had commercial insurance.
Overall, reoperations led to a 24% higher cost for patients, regardless of whether they had commercial insurance or Medicare. Specifically, researchers noted that incremental costs would be $221,607 for patients with commercial insurance and $8,559 for patients with Medicare.
“[Patients may] have to go through a mastectomy that is much higher [in cost], as they require more expensive surgery. So that can be [a way of] addressing the first step to lower the complication,” said Kim.
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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.
Kim also noted that the study compared insurance costs, not only between commercial insurance and Medicare but also between patients with ductal carcinoma in situ (DCIS) and patients with other types of breast cancer. The study found that patients with DCIS had higher rates of reoperation, compared with patients with other types of breast cancer, Kim said.
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 [and patients with] DCIS had a much higher risk for reoperation,” Kim explained. “So in our cohort, we found that [patients with DCIS] had a 40% [risk for reoperation].”
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