Trends in Reoperation After Initial Lumpectomy for Breast Cancer

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Abstract
Physicians are increasingly aware of the need to address overtreatment in cancer care. Breast cancer exemplifies these concerns because most newly diagnosed patients with a favorable prognosis are treated with multiple modalities for which the benefit of each treatment may be small, but the burden is cumulative and substantial.1 Surgeons increasingly recognize that with multimodality treatment, “bigger” surgery is not necessarily better, making surgery a particular focus of initiatives to reduce the burden of treatment.2,3 However, the use of breast-conserving surgery (BCS) has recently declined after years of steadily increasing rates, accompanied by increased use of bilateral mastectomy.4,5 Although BCS is a less morbid surgical approach, an important downside to its use is the historically high rate of additional operations (reexcision lumpectomy and/or mastectomy) after initial lumpectomy, ranging from 23% to 38% in published reports.6,7

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