Factors related to re-excision procedures following primary breast-conserving surgery for women with breast cancer in the U.S. Military Health System
Yvonne L. Eaglehouse MPH, PhD
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Search for more papers by this authorMatthew W. Georg MPH
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Search for more papers by this authorIsmail Jatoi MD, PhD, FACS
Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
Search for more papers by this authorCraig D. Shriver MD, FACS
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
Search for more papers by this authorCorresponding Author
Kangmin Zhu MD, PhD
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Correspondence Dr Kangmin Zhu, MD, PhD, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817.
Email: [email protected]
Search for more papers by this authorYvonne L. Eaglehouse MPH, PhD
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Search for more papers by this authorMatthew W. Georg MPH
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Search for more papers by this authorIsmail Jatoi MD, PhD, FACS
Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
Search for more papers by this authorCraig D. Shriver MD, FACS
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
Search for more papers by this authorCorresponding Author
Kangmin Zhu MD, PhD
Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Correspondence Dr Kangmin Zhu, MD, PhD, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817.
Email: [email protected]
Search for more papers by this authorAbstract
Background and Objectives
Re-excision surgery is undertaken to obtain clear margins after breast-conserving surgery (BCS) for localized breast cancer. This study examines patient and tumor characteristics related to re-excision surgery in the universal-access Military Health System (MHS).
Methods
Retrospective analysis of patients with pathologically confirmed stage I-III breast cancer between 1998 and 2014 in the Department of Defense Central Cancer Registry and MHS Data Repository–linked databases who received primary BCS. Multivariable stepwise logistic regression methods identified characteristics associated with re-excision surgery (lumpectomy and mastectomy) and conversion to mastectomy, given as adjusted odds ratios (AOR) and 95% confidence intervals (CIs).
Results
Of 7637 women receiving BCS, 26.3% had a re-excision and 9.9% converted to mastectomy. Tumor location, larger tumor size (≥4 cm), and regional lymph node involvement were associated with a greater likelihood of re-excision and mastectomy conversion. Pathology before BCS (AOR, 0.39; 95% CI, 0.35, 0.44 for re-excision) and neoadjuvant treatment (AOR, 0.50; 95% CI, 0.36, 0.69 for re-excision) were associated with a decreased likelihood of these outcomes. Additionally, age, tumor histology, and military-specific variables were associated with mastectomy conversion.
Conclusion
Comprehensive preoperative workup, including tumor pathology, may better inform surgical decision-making and reduce re-excision rates.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are not publicly available due to the sensitive nature of the data. The Department of Defense Central Cancer Registry (CCR) data may be requested from the Joint Pathology Center (https://www.jpc.capmed.mil/request_release.asp); and the Military Health System Data Repository (MDR) data may be requested from the Defense Health Agency (https://www.health.mil/Military-Health-Topics/Technology/Support-Areas/MDR-M2-ICD-Functional-References-and-Specification-Documents). Restrictions apply to the access and use of these data.
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