OBJECTIVES : This retrospective review describes surgical treatment patterns, surgical healthcare costs and complication rates in women who received breast conserving surgery (BCS).

METHODS : The IBM MarketScan Commercial and Medicare database was used to identify a retrospective cohort of women aged 21 years and older who underwent BCS within 180 days of a new diagnosis of breast cancer between 2013 and 2018. Only women who had ≥12 months of continuous insurance enrollment pre and post cancer diagnosis were eligible for inclusion. Outcomes were the frequency, timing, and costs of additional surgeries (repeat BCS, mastectomy, breast reconstruction) and complications following BCS.

RESULTS : 5,584 women treated with BCS were included. The median time between diagnosis and initial BCS was 23 days. Approximately one quarter (27%) of women receiving BCS underwent additional surgery (mastectomy or repeat BCS) within 1 year of diagnosis. The median time between initial and subsequent surgeries was 48 days for women undergoing repeat BCS and 42 days for women undergoing mastectomy following BCS. Women with repeat BCS incurred an average of $6,823 in total healthcare costs on the day of their repeat BCS and women receiving mastectomy incurred an average of $26,783 in healthcare costs on the day of mastectomy. 10% of women undergoing initial BCS had breast reconstruction within 1 year. The median time between initial BCS and reconstruction was 29 days. Women undergoing breast reconstruction incurred an average of $28,181 in healthcare costs on the day of breast reconstruction. Among women undergoing BCS, 25% were diagnosed with pain, 7% with lymphedema, 4% with seroma, 3% with breast abscess within 1 year of undergoing BCS.

CONCLUSIONS

: Approximately one-third (37%) of women who underwent breast conserving surgery following a breast cancer diagnosis have additional surgery at significant additional direct cost ($6,823 to $28,181). Complications were noted in more than a third of women post-BCS.