Surgical management of women with screen-detected breast cancer: preoperative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer

Seventeen percent of women undergoing surgery for screen-detected breast cancer undergo more than one operation (BASO audit 2008). The aim of this study is to identify pre-operative data items that predict which cases will require more than one application.

Over an 11 year period (April 1996 to April 2007) 1,193 women presented with screen-detected breast cancer through the South East London Breast Screening Programme. For each case, imaging and biopsy data were reviewed in order to predict which women undergoing wide local excision (WLE) would require further operations. Age, invasive cancer size, ductal carcinoma in situ (DCIS) size, histology, cancer grade, nodal status, mammographic sign and level of suspicion of malignancy (RCR Breast Group 1-5 scale) were compared.

Of the 1,193 women, 916 (77%) had a WLE or excision biopsy. These were split into two groups: group 1 (520 women (57%)) had a single operation; and group 2 (396 women (43%)) went on to have further operations, including repeat WLE to clear margins 238 (60%), mastectomy 133 (34%) and axillary dissection 25 (6%). Twenty-eight women went on to have a third operation. There were significant associations with increasing size of DCIS (P < 0.001), increasing tumour grade (P = 0.005), radiologists suspicion of 3/4 (P = 0.002) and mammographic sign (spiculated mass plus micro-calcifications and asymmetric density (ASD), P = 0.003) for repeat operations. There was no statistical difference in patient's age, invasive cancer size, histology or nodal status.

The multidisciplinary team should pay particular attention to DCIS extent and mammographic features of the tumour when planning surgical management in order to minimise the number of women requiring repeat operations.