Breast Cancer Surgery Increasing at VA

INDIANAPOLIS — Women will make up approximately 10% of the VA healthcare system by 2020 and 15% by 2030, meaning that the need for women’s health services, including breast cancer treatment, will increase.

How is the healthcare system responding, and what are some of the trends in surgical approaches? A research letter published recently in JAMA Surgery sought to answer those questions.1

A study team led by Indiana University researchers and including participation from the Louis Stokes VAMC in Cleveland and the R.L. Roudebush VAMC in Indianapolis used the VHA Services Support Center database to conduct a review of veteran patients undergoing mastectomy or reconstructive breast procedures from 2007 to 2014.

Researchers determined that 5,673 mastectomies and 2,223 reconstructive procedures were performed between 2007 and 2014. The total number of breast operations increased by a mean of 63 cases per year.

Results indicated that mastectomy procedures increased significantly by a mean of 35 cases per year, while breast reconstructions went up by a mean of 28 cases annually. Also increasing was free-flap reconstruction by a mean of two cases a year.

The rate of reconstruction after mastectomy was 25% to 42% between 2007 and 2014. At the same time, partial mastectomies and simple mastectomies showed a significant rise for a mean of 6 and 17 cases a year, respectively. Modified radical mastectomies showed a decreased trend, however, although it was insignificant. Partial mastectomies were used in 30% to 50% of all the procedures, the report noted.

The study further pointed out, “Breast cancer treatment continues to evolve, helping to improve survival and quality of life in affected patients. As of 2012, the incidence of breast cancer accounted for 1% of cancers within the VA3; however, the incidence of breast cancer will continue to increase as the female veteran population grows.”

Researchers also stated that systems with multidisciplinary breast cancer programs have shown reconstruction rates of approximately 50% to 60%, and that, with only seven VA hospitals providing oncologic breast surgery, reconstruction rates at the healthcare system ranged from 26% to 42% since 2007.

“Although reconstruction rates are increasing, expanding designated breast oncology/surgery programs with multidisciplinary approaches to treatment within the VA may be necessary to meet rising demands and decrease the number of ‘fee out’ services,” study authors concluded, adding, “As the number of women in the military rises, it will be crucial to improve breast cancer treatment and reconstruction for veterans. Initiatives to expand access to breast oncologic and reconstructive surgeons, enhancing facilities, and improving women’s services will be essential in providing future quality care.”

  1. Evans TA, Duquette S, Soleimani T, Christensen LF, Munshi I, Cohen A, Tholpady SS. Trends in Surgical Treatment of Breast Cancer in the Veterans Affairs System. JAMA Surg. 2017 Mar 1;152(3):305-306. doi: 10.1001/jamasurg.2016.3191. PubMed PMID: 27902814.

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