A study has found that nearly 25% of women who had lumpectomy (also sometimes called breast conserving surgery or partial mastectomy) had to have more surgery once doctors had all the information about the breast tissue removed during the lumpectomy. The results were published in the Feb. 1, 2012 issue of the Journal of the American Medical Association.
Lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk was about the same with either type of surgery.
During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue (called the margin) that surrounds it. After lumpectomy, a pathologist carefully examines the tissue that was removed to see if cancer cells are present in the margins. Margins that are free of cancer are called "negative" or "clean." Margins that have cancer cells in them are called "positive."
Ideally, the surgeon learns the status of the margins before the lumpectomy is completed, so as much tissue as needed can be removed until the margins are clean. Unfortunately, analyzing the removed tissue takes about a week. Sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery is needed. This additional surgery is called a re-excision lumpectomy.
Because all the breast tissue is removed during mastectomy, the need for more surgery isn't as much of an issue.
Researchers followed 2,206 women who had lumpectomy to remove early-stage breast cancer. Nearly 25% of the women had to have re-excision surgery:
- Most of the women who needed re-excision needed only one more surgery, but 11% needed two or more additional surgeries.
- 9% of the women eventually had mastectomy.
As you might expect, the researchers found that women who had wide margins removed during lumpectomy were less likely to require re-excision surgery compared to women who had narrow margins removed. Each surgeon doing lumpectomy must balance the size of the margin removed against the cosmetic impact of the total amount of breast tissue removed.
If you've been diagnosed with early-stage breast cancer and are planning treatment, you and your doctor will consider which type of surgery makes sense for you based on your unique situation. For many women, lumpectomy followed by radiation therapy is a good option and more attractive than mastectomy, both physically and emotionally.
Still, choosing lumpectomy means possible repeat surgery after the lumpectomy tissue removed is analyzed. Talk to your doctor about any concerns you have about this possibility and how your concerns might influence the type of surgery you choose. If you choose lumpectomy, ask your surgeon how she or he will decide how wide the lumpectomy margins should be and how that might be influenced by your concerns about the need for re-excision surgery. Together, you and your doctor can decide on a surgical plan that is right for YOU.
Editor's Note: To help standardize the definition of negative margins, the American Society for Radiation Oncology and the Society of Surgical Oncology issued new guidelines in February 2014 saying that clear margins, no matter how small as long as there was no ink on the cancer tumor, should be the standard for lumpectomy surgery.