As many of you have observed from personal experience, doctors disagree on the definition of an adequate surgical margin in a lumpectomy. To reduce confusion, worry and unnecessary second surgeries yet maintain excellent outcomes, the Society of Surgical Oncology (SSO) has created a "definitive guideline."
Roughly 25 percent of breast cancer patients return to the operating room following lumpectomies to obtain more normal tissue around the cancer, and this often results in mastectomies. In about half of these cases, the tumor has been removed and the margin is free of cancer cells, but doctors have believed that a larger amount of normal breast tissue might reduce the risk of cancer recurrence.
The new guideline: No cancerous cells should touch the edge of the lumpectomy specimen. Beyond that, additional surgery is not effective. This is true for women of all ages and with all forms of breast cancer, including triple-negative.
To develop the guideline, an expert methodologist conducted a comprehensive review of the available scientific evidence. Leaders in surgical oncology, radiation oncology, medical oncology, pathology and patient advocacy then met to review the findings and develop a consensus.
"Our hope is that this guideline will ultimately lead to significant reductions in the high re-excision rate for women with early-stage breast cancer undergoing breast conserving surgery. Based on the consensus panel's extensive review of the literature, the vast majority of re-excisions are unnecessary because disease control in the breast is excellent for women with early-stage disease when radiation and hormonal therapy and/or chemotherapy are added to a woman's treatment plan," said Meena S. Moran, MD, Associate Professor of Therapeutic Radiology at Yale School of Medicine and Yale Cancer Center and co-chair of the Margin Consensus Panel.
You can download the guidelines and accompanying research on the SSO's website.
Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
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2 comments:
Unless the woman is brca1 positive, if I understand correctly, in which case a double mastectomy is recommended. Is that reflected in these guidelines?
These guidelines make no exceptions for any subtypes. That means those with BRCA mutations do not benefit from additional surgery. My thought on all this, though, is to go with your gut. If you feel additional surgery is the way to go, do it. It's your body. These do show, though, that positive margins are important, but they can be tiny and still effective. Hope that helps.
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