Association of Biopsy Procedures During Follow-up for Breast Cancer With Surgical Decision Making in Patients

Abstract

The 2 main options for the surgical management of breast cancer are breast-conserving surgery (BCS) with whole-breast irradiation (WBI) or mastectomy, together with some form of axillary staging. A 20-year follow-up of a randomized clinical trial comparing the 2 options showed no difference in overall survival. 1 Local recurrence in the ipsilateral breast was 14.3% in the group receiving BCS with WBI and 39.2% in those who did not receive radiotherapy. 1 Breast-conserving surgery with intraoperative radiotherapy has equivalent outcomes in patients with good prognostic features. 2 The 10-and 20-year actuarial rates of contralateral breast cancer were 6.1% and 12%, respectively, in the Surveillance, Epidemiology, and End Results (SEER) database. 3 Women who have received a unilateral mastectomy need an annual mammography on the intact breast, and those who have undergone BCS require bilateral mammography. 4 Surveillance is likely to identify breast lesions requiring a biopsy to rule out malignant disease. Little information is available on the biopsy rate after BCS or mastectomy.In this issue of JAMA Surgery, van la Parra et al 5 have attempted to address this issue by determining the frequency of breast biopsies in 2 large cohorts of patients with breast cancer diagnosed from January 1, 2000, through December 31, 2011, by using a commercial insurance database (MarketScan Commercial Claims and Encounters database; Truven Health Analytics) (41 510 patients) and the