Women who have breast surgery in specialised hospitals and by specialised surgeons are less likely to need a second operation.

Research published today by the National Cancer Registry shows that almost one-fifth of Irish women having breast-conserving surgery in 2002-2008 needed one or more additional operations. Almost ⅔ of these went on to have a total removal of the breast (mastectomy). Although very little comparable information is available from other countries, the rate of re-operation in Ireland is not unusual, although the proportion needing mastectomy was high.

Older women, and those whose cancer was diagnosed through screening, were less likely to have a second operation. The most important finding was that women who had their first surgery in a hospital treating a large number of breast cancer patients were less likely to have a second operation. Similarly, women treated by a surgeon with a high breast cancer caseload were less likely to have a second operation, or to have a mastectomy if they had a second operation.

Breast-conserving surgery is the preferred option for women with small breast lumps, but as this research shows, in a significant number of cases, this option proves insufficient, and women must undergo the trauma of a second operation. The study did not show why there was a lower rate of re-operation in larger hospitals; this may have been due to many factors, including better selection of women for breast-conserving surgery, greater surgical skill or closer adherence to treatment guidelines. Whatever the reason, this research further emphasises the benefits of having breast surgery carried out by specialised surgeons in specialised hospitals. The centralisation of breast cancer surgery in public hospitals into eight designated cancer centres was completed by the National Cancer Control Progamme in 2009.

An abstract is available at http://link.springer.com/article/10.1007/s10549-013-2652-5) and the full text from the first author (m.cancela [at] ncri.ie).

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