Reducing Repeat Operations for Women with Breast Cancer

The Problem

  • 80% of women with Stage I or II breast cancer are eligible to undergo lumpectomy followed by radiation. A repeat operation is needed if “adequate margins” are not achieved, leading to increased cost and burden for patients and hospitals.
  • Surveys of surgeons have found considerable inconsistencies in the definition of “adequate margins,” leading to significant variation in rates of reoperation, ranging from 0-70% in Wisconsin.
  • A national consensus conference of experts in breast cancer care developed a toolkit of evidence-based interventions at the surgeon and hospital level to minimize repeat operations. Interventions include:
    • Complete diagnostic mammography (and ultrasound when needed), minimally invasive breast biopsy, and preoperative multidisciplinary planning
    • Preoperative localization of non-palpable lesions, intraoperative pathology, and specimen imaging
    • Oncoplastic lumpectomy technique, cavity shaves, and compliance with the SSO-ASTRO Margin Guideline
  • Despite publication of the toolkit, rates of reoperation for women with breast cancer remain high and vary considerably.

How will SCW help?

  • Provide confidential, benchmarked performance reports at hospital and surgeon levels using existing administrative data for rates of reoperation and mastectomy.
  • Distribute a comprehensive toolkit to assist in implementation of evidence-based interventions, tailored to each practice setting.
  • Create a platform for both in-person and virtual collaborative learning.
    • Opportunities for interactive problem solving and brainstorming
    • Overview of specific topics, prioritized by participating hospitals

Interested in Participating?

  • Click here to learn how you can join.
  • We welcome participation by surgeons, nurses quality improvement specialists, and others involved in the care of patients with breast cancer.
  • Click on the toolkit below to view sample performance reports, recommended readings and more. 

Initiative Leaders

Amanda Kong, MD, FACS

Amanda Kong, MD, FACS

Medical College of Wisconsin

Contact Here

Joseph Weber, MD, FACS

Joseph Weber, MD, FACS

Aurora Health Care

Contact Here

Why Breast Cancer Surgery?

R

Location

Surgical procedures for breast cancer are commonly performed in the majority of hospitals across Wisconsin, and there is wide variation in observed rates of repeat operations for positive margins. 

Evidence-based guidelines have impact

A toolkit of evidence-based interventions was developed by a national consensus conference with the goal of improving breast cancer care by minimizing the need for repeat operations. 

Ensure equal access to high-quality surgical care

Despite clear benefits, elements of the toolkit are challenging to implement because they require both surgeon- and system-level changes in the way care is delivered. 

Working together to bring high-quality surgical care to the entire state of Wisconsin