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About 25% of Women Need More Surgery After Lumpectomy

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A study has found that about 25% of women who have lumpectomy (also called breast conserving surgery or partial mastectomy) have to have more surgery once their doctors have all the information about the cancer and breast tissue that was removed.

The results were published online on Nov. 12, 2014 by JAMA Surgery. Read the abstract of “Repeat Surgery After Breast Concervation for the Treatment of Stage 0 to II Breast Carcinoma: A Report From the National Cancer Data Base, 2004-2010."

These new results are very similar to the results of two other studies published in 2012.

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 is around it. After lumpectomy, a pathologist carefully examines the tissue that was removed to see if cancer cells are in the margins. Margins that have no cancer are called “negative” or “clean.” Margins that have cancer cells are called “positive.”

In a perfect world, your surgeon would learn 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 a mastectomy, there’s usually no need for more surgery.

In this study, the researchers looked at the records of 316,114 women diagnosed with stage 0 to stage II breast cancer (considered early-stage disease). All the women had lumpectomy between Jan. 1, 2004 and Dec. 31, 2010.

The researchers found:

  • 241,597 women (76.4%) had just the one lumpectomy surgery
  • 74,517 women (23.6%) had at least one additional surgery

Of the women who had more than one surgery:

  • 46,250 (62.1%) had another lumpectomy
  • 28,267 (37.9%) had a mastectomy

The researchers also looked to see if any cancer characteristics increased the chances that a woman would need more surgery:

  • the larger the cancer, the more likely the woman was to have more surgery

The researchers also found that women who were treated at university research clinics were more likely to have repeat surgery than women who were treated at non-research community hospitals.

If you’ve been diagnosed with early-stage breast cancer and are planning your treatment, you and your doctor will consider which type of surgery makes the most 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. Together, you and your doctor can decide on a surgical plan that is right for YOU.

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