Should Re-excision Lumpectomy Rates Be a Quality Measure in Breast-Conserving Surgery?
In response to recognition of variation in the quality of national healthcare, physicians and their professional societies have emphasized the need for quality measurement and improvement.1 Multiple organizations have now developed breast-specific quality measures (QM) to aid quality improvement (QI).2–6 Many of these QM have been incorporated into national quality initiatives that provide peer performance comparison and some level of transparency. In addition, during the last decade, the American Society of Breast Surgeons (ASBS), the National Accreditation Program for Breast Centers (NAPBC), and the National Consortium of Breast Centers (NCBC) have defined and endorsed multiple breast-specific quality measures.2–4
A QM is an attempt to quantify quality in a domain of care. The most common historical domains of care are “structure of care,” “process of care,” and outcomes. Recently, “patient centeredness (experience)” and “affordability” have been emphasized as other important domains ...
- Kaufman, CS, Landercasper, J (2011) Can we measure the quality of breast surgical care?. Ann Surg Oncol. 18: pp. 3053-3060 CrossRef
- American Society of Breast Surgeons Mastery Program. Available: https://www.breastsurgeons.org/mastery/index.php.
- National Accreditation Program for Breast Centers Standards Manual. Available: http://napbc-breast.org/standards/standards.html.
- National Consortium of Breast Centers Quality Measurement Program. Available: http://www.nqmbc.org/about/About.htm.
- American Society of Clinical Oncology Quality Oncology Performance Initiative. Available from: http://www.asco.org/qopi.
- Commission on Cancer endorsed Quality Measures. Available: http://www.facs.org/cancer/qualitymeasures.html.
- Berwick, DM, Nolan, TW, Whittington, J (2008) The triple aim: care, health and cost. Health Aff. 27: pp. 759-769 CrossRef
- National Quality Forum Measure Evaluation Criteria. Available: http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx.
- a new health system for the 21st century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. CA Cancer J Clin. 58: pp. 266-292 CrossRef
- Quality Agency for Healthcare Research and Quality. Tutorials on Quality Measures. U.S. Department of Health and Human Services, 2013. Available: http://www.qualitymeasures.ahrq.gov/tutorial/varieties.aspx. Accessed 22 May 2013.
- Neumayer, L, Schifftner, TL, Henderson, WG, Khuri, SF, El-Tamer, M (2007) Breast cancer surgery in Veterans Affairs and selected university medical centers: results of the patient safety in surgery study. J Am Coll Surg. 204: pp. 1235-1241 CrossRef
- American Society of Breast Surgeons. Position Statement on Breast Cancer Lumpectomy Margins, 2013. Available: https://www.breastsurgeons.org/statements/PDF_Statements/Lumpectomy_Margins. Accessed 22 May 2013.
- Morrow, M, Katz, SJ (2012) The challenge of developing quality measures for breast cancer surgery. JAMA. 307: pp. 509-510 CrossRef
- McCahill, LE, Single, RM (2012) Aiello Bowles EJ, Feigelson HS, James TA, Barney T, Engel JM, Onitilo AA. Variability in reexcision following breast conservation surgery. JAMA. 307: pp. 467-475 CrossRef
- Canadian Institute for Health Information on quality of care. Available: http://www.cihi.ca/CIHI-extportal/internet/en/Document/health+system+performance/quality+of+care+and+outcomes/outcomes/RELEASE_11OCT12. Accessed 20 June 2013.
- Jeevan, R, Cromwell, DA, Trivella, M, Lawrence, G, Kearins, O, Pereira, J, Sheppard, C, Caddy, CM, Meulen, JH (2012) Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ. 345: pp. e4505 CrossRef
- Coopey, S, Smith, BL, Hanson, S, Buckley, J, Hughes, KS, Gadd, M, Specht, MC (2011) The safety of multiple re-excisions after lumpectomy for breast cancer. Ann Surg Oncol. 18: pp. 3797-3801 CrossRef
- Houssami, N, Macaskill, P, Marinovich, ML, Dixon, JM, Irwig, L, Brennan, ME, Solin, LJ (2010) Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 46: pp. 3219 CrossRef
- Dunne, C, Burke, JP, Morrow, M, Kell, MR (2009) Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 27: pp. 1615-1620 CrossRef
- NCCN Guideline for breast cancer. Available: www.nccn.org. 2013.
- Azu, M, Abrahamse, P, Katz, SJ, Jagsi, R, Morrow, M (2010) What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 17: pp. 558-563 CrossRef
- Taghian, A, Mohiuddin, M, Jagsi, R, Goldberg, S, Ceilley, E, Powell, S (2005) Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 241: pp. 629-639 CrossRef
- Blair, SL, Thompson, K, Rococco, J, Malcarne, V, Beitsch, PD, Ollila, DW (2009) Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons?. J Am Coll Surg. 209: pp. 608-613 CrossRef
- Morrow, M, Harris, JR, Schnitt, SJ (2012) Surgical margins in lumpectomy for breast cancer—bigger is not better. N Engl J Med. 367: pp. 79-82 CrossRef
- Persing, S, James, TA, Mace, J, Goodwin, A, Geller, B (2011) Variability in the quality of pathology reporting of margin status following breast cancer surgery. Ann Surg Oncol. 18: pp. 3061-3065 CrossRef
- Esbona, K, Li, Z, Wilke, LG (2012) Intraoperative imprint cytology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Ann Surg Oncol. 19: pp. 3236-3245 CrossRef
- Clarke, M, Collins, R, Darby, S (2005) Effects of radiotherapy and differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 366: pp. 2087-2106
- Cardoso, MJ, Cardoso, JS, Vrieling, C, Macmillan, D, Rainsbury, D, Heil, J, Hau, E, Keshtgar, M (2012) Recommendations for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat. 135: pp. 629-37 CrossRef
- Cano, SJ, Klassen, AF, Scott, AM, Pusic, AL (2013) A closer look at the BREAST-Q©. Clin Plast Surg. 40: pp. 287-96 CrossRef
- Should Re-excision Lumpectomy Rates Be a Quality Measure in Breast-Conserving Surgery?
Annals of Surgical Oncology
Volume 20, Issue 10 , pp 3180-3183
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
- 2. Department of Surgery, Mayo Clinic, Rochester, MN, USA
- 3. Norma J Vinger Center for Breast Care, Department of Surgery, Gundersen Health System, LaCrosse, WI, USA