Repeat Surgery After Lumpectomy For Breast Cancer May Not Be Needed

There was an article recently published in the Journal of the American Medical Association which showed that almost 25% of lumpectomies for breast cancer are followed by re-excision surgery, although this varies widely across surgeons and centers.

What’s more alarming is that half of these re-excisions were in patients with negative margins, or in plain terms, patient’s whose cancers were already fully removed during the first surgery!

There has always been debate about an acceptable width of tumor free margins. Recent literature suggests that as long as there are no tumor cells touching the margin of the specimen, then that is an adequate enough resection. Patients will then be getting radiation therapy which will reduce the likelihood of local recurrence.

So what is the reason for such a high rate of what appears to be overtreatment? The authors of the study suggested that practices at the specific institutions where patients were treated may have an influence on re-excision rates. Other possible explanations may consist of differences in training, confidence in localizing the tumor, and co-ordination of specimen orientation and margin interpretation between the surgeon and the pathologist.

The researchers hinted that the most important factor on deciding whether to perform repeat surgery after the initial lumpectomy is what each surgeon accepts as an adequate margin. What most of these surgeons likely fail to take into account when making their decisions is the significant physical and psychological impact these possibly unnecessary re-excision surgeries have on these breast cancer patients. Many of these women may end up losing their whole breast for no reason. That is why it is important to have the oncologists and radiation oncologists involved in the patients’ care prior to their surgeries.

 

 

The full article can be found here

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