Abstract
BackgroundBleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence.MethodsUsing the Danish Breast Cancer Group database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I–III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996–2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from the DNPR. Follow-up began 14 days after primary surgery and continued until breast cancer recurrence, death, emigration, 10 years of follow-up, or 1 January 2013. Incidence rates of breast cancer recurrence were calculated and Cox regression models were used to quantify the association between reoperation and recurrence, adjusting for potential confounders. Crude and adjusted hazard ratios according to site of recurrence were calculated.ResultsAmong 30 711 patients (205 926 person-years of follow-up), 767 patients had at least one reoperation within 14 days of primary surgery, and 4769 patients developed breast cancer recurrence. Median follow-up was 7·0 years. The incidence of recurrence was 24·0 (95 per cent c.i. 20·2 to 28·6) per 1000 person-years for reoperated patients and 23·1 (22·5 to 23·8) per 1000 person-years for non-reoperated patients. The overall adjusted hazard ratio was 1·06 (95 per cent c.i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence.ConclusionIn this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence.
Highlights
Breast cancer is the most common cancer among women, with about 1⋅67 million new patients diagnosed in 20121
The cohort consisted of 30 711 women after exclusion of 2425 women with more than 1 day difference in the date of surgery, or inconsistency in type of surgery, between the Danish National Patient Register (DNPR) and the Danish Breast Cancer Group (DBCG) database, and 26 women who died or had an event registered before the start of follow-up
Previous research in Danish patients reported an association between re-excision and increased risk of ipsilateral breast tumour recurrence[31]
Summary
Breast cancer is the most common cancer among women, with about 1⋅67 million new patients diagnosed in 20121. Postoperative bleeding requiring reoperation occurs in up to 4 per cent of women undergoing surgery for breast cancer[4]. Depending on the age of the patient and extent of primary surgery (mastectomy versus BCS)[5], the use of certain prescription drugs (such as selective serotonin reuptake inhibitors (SSRIs) or glucocorticoids) increases the risk of postoperative bleeding requiring reoperation[5,6]. Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. Results: Among 30 711 patients (205 926 person-years of follow-up), 767 patients had at least one reoperation within 14 days of primary surgery, and 4769 patients developed breast cancer recurrence. Conclusion: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence
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