Guidelines Aim to Reduce 2nd Surgeries After Breast Cancer Lumpectomy

News Picture: Guidelines Aim to Reduce 2nd Surgeries After Breast Cancer LumpectomyBy Steven Reinberg
HealthDay Reporter

WEDNESDAY, Nov. 12, 2014 (HealthDay News) -- In a study of more than 240,000 women who had breast conservation surgery for breast cancer, nearly 25 percent needed a second operation, a new study finds.

"There are very few operations where you would expect to have a second surgery," said lead researcher Dr. Lee Wilke, director of the section of surgical oncology at the Breast Cancer Center at the University of Wisconsin School of Medicine and Public Health in Madison. "This is traumatic for women from a psychological standpoint and can result in poorer cosmetic outcomes."

Removing all of a tumor is the best way to reduce the odds of it returning, but until recently there hasn't been agreement on how much breast tissue needs to be removed at the edges of a tumor during the breast-conserving procedure, commonly called a lumpectomy. This lack of consensus has led to the high rate of second surgeries, the researchers suggested.

In hopes of reducing the odds of a second operation after an initial lumpectomy, the Society of Surgical Oncology and the American Society for Radiation Oncology recently defined what they mean by having all the cancer removed, Wilke noted.

Before these new guidelines, there was no clear definition of what "no tumor left behind" meant, she added.

"The new standard is, 'no tumor on ink,'" Wilke explained. During a lumpectomy, the edges of the area removed are inked. As long as there are no cancer cells remaining in that inked area, doctors should consider all the cancer removed, she explained.

The report was published online Nov. 12 in the journal JAMA Surgery.

If these new guidelines are adopted, the number of second surgeries will be significantly reduced, said Dr. Julie Margenthaler, an associate professor of surgery at Washington University School of Medicine in St. Louis and co-author of an accompanying journal editorial.

"It is estimated that up to 30 to 50 percent of patients who have second surgeries following a lumpectomy do not need them based on these guidelines," she said.

"We encourage all breast surgeons to rapidly adopt these guidelines, to reduce unnecessary additional surgeries and the costs that are associated with this -- both for the patient and the health care system," Margenthaler said.

For the study, Wilke's team collected data on more than 240,000 women with breast cancer who had breast conservation surgery from 2004 through 2010.

Among these women, more than 76 percent had a single lumpectomy and almost 24 percent had to have at least one additional surgery.

Of the patients who had a second operation, about 62 percent had a completion of their lumpectomy and nearly 38 percent had the breast completely removed -- a mastectomy.

Over the period of the study, the number of women needing a second operation fell from 25.4 percent to 22.7 percent, the researchers found.

In addition, more second operations were done at teaching hospitals than at community hospitals (26 percent versus 22.4 percent). And more second operations were done in the Northeast than in the Mountain states (26.5 percent versus 18.4 percent), the study reports.

The two main factors associated with the need for a second surgery were the size and type of tumor, the researchers explained.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said that some women will still need a second operation after a lumpectomy.

"You need to speak with your doctor. There are individual factors that come into play," she said. "It will take some time to fully adopt these guidelines because doctors will still look at the individual patient and try to see if the guidelines make sense."

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SOURCES: Lee Wilke, M.D., director, section of surgical oncology, breast cancer center, University of Wisconsin School of Medicine and Public Health, Madison; Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Julie Margenthaler, M.D., associate professor, surgery, Washington University School of Medicine, St. Louis; Nov. 12, 2014, JAMA Surgery, online