A large scale study of breast cancer patients from the Breast Cancer Center at the University of Wisconsin School of Medicine and Public Health in Madison, revealed almost a quarter of women who had undergone breast conservation surgery ended up needing a second operation.
Lead investigator and director of surgical oncology at the center, Dr. Lee Wilke, explains the available surgical options that would likely lead to a second operation are actually quite few, but when the need does arise, it can be extremely disappointing, if not traumatic, for women. A second procedure would also lead to poorer cosmetic outcomes.
Dr. Wilke’s study collected information from over 240,000 breast cancer patients that had undergone breast conservation surgery between the years 2004 and 2010. They noted 76% of the participants had only one operation – a single lumpectomy, but nearly 25% underwent a second surgery. Out of this number, 62% only consented to a completion of the previous lumpectomy, while the remaining 38% chose a mastectomy, or a complete removal of the breast. The researchers believe the primary factors that determine the necessity for a second operation are the type of tumor and its size.
In order to drastically minimize cancer recurrence, a complete removal of the tumor is necessary. However, there are discrepancies in the recommended amount of breast tissue to be removed along the edges of a tumor during a breast-conserving procedure, or lumpectomy. The lack of compliance to a set standard may be causing these seconds surgeries. The Society of Surgical Oncology and the American Society for Radiation Oncology noted these incidences and recently published a modified set of recommendations and guidelines on what it means to have all the cancer removed.
Dr. Wilke explains, today’s new standard is “no tumor on ink”. This refers to the inked area during a lumpectomy. So long as there are no remaining cancer cells in the inked area, a cancer may be considered completely removed and should have very minimal chance of recurrence. This report is available online in the November 12 issue of the JAMA Surgery.
Dr. Julie Margenthaler, an associate professor of surgery at Washington University School of Medicine in St. Louis, said a nationwide awareness of these new standards will drastically reduce the need for second surgeries. According to the new guidelines, 30%-50% of patients who went for a second operation wouldn’t have needed one. This underscores the need for all breast surgeons to follow the new guidelines to lessen health costs and stress on the patient side.
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