OBJECTIVES: ~20-25% of patients who undergo a primary lumpectomy for the treatment of breast cancer require a reoperation due to adverse outcomes like positive surgical margins or cancer recurrence. We analyze the economic impact of patients who require repeat breast tissue resection as part of their treatment.

METHODS: We used the Merative MarketScan Research Database, containing patient-level data on individuals with commercial or Medicare Supplemental insurance coverage in the United States. From 2016-2021, we identified women who received an index lumpectomy for the treatment of primary breast cancer and identified their healthcare encounters 1 year post-operatively, including any repeat lumpectomies or mastectomies. We aggregated total healthcare expenditures and out-of-pocket costs among patients with at least 3 years of continous enrollment in their insurance plan. Patients with greater than 3 breast excision/resection procedures were excluded.

RESULTS: Among 9,409 patients with a primary lumpectomy, 25% (n=2,315) underwent a secondary breast surgery, of which 75% (n=1,730) was a repeat lumpectomy and 25% (n=585) was a mastectomy. Median time to second procure was 3 weeks (IQR: 1.3-7.7) and 5% (n=438) underwent a 3^rd procedure. Lower age and smoking, but not high BMI, were associated with increased risk of reoperation, as well as risk of mastectomy instead of lumpectomy as a secondary procedure. Median healthcare expenditure for primary lumpectomy plus one year follow up was $38,811 USD ($695 out-of-pocket). Among patients with a secondary procedure, median healthcare expenditure from primary lumpectomy plus one year follow up was $43,761 ($980 out-of-pocket) for repeat lumpectomy and $63,782 ($777 out-of-pocket) for subsequent mastectomy patients.

CONCLUSIONS: While lumpectomy is the most common surgical therapy for early-stage breast cancer, it often is not a definitive procedure, which can result in large added financial and operational burdens. Patient risk stratification and intraoperative adjuncts are needed to minimize risk of reoperation.