Lumpectomy No Longer Means Repeat Surgery Likely Thanks To New Guidelines

Surgery (stock)

Women who've chosen bilateral mastectomy ("lumpectomy") versus full mastectomy have had increased risk of return for surgery. This was due to the variance in removal guidelines regarding "clean" tissue around the cancer. Changes to those guides have resulted in a large and continuing decline in repeat surgeries.

Repeat surgeries, including mastectomies, declined by 16 percent from 2013 to 2015, a new study says. This corresponds with a more universal cancer-free margin removal guideline now being used by most surgeons.

Before recommendations were published in 2014, disagreement about cancer-free margins for surgery were widely varied.

Some doctors went further than others, removing more healthy tissue, while others did the opposite. The result was that 23 to 38 percent of women who received a lumpectomy would return to the operating room to have more tissue removed. Often this meant a full mastectomy.

Radiologists and surgeons were concerned about these return rates and worked to establish an accepted standard for lumpectomy margins. After reviewing studies to find common ground, the American Society for Radiation Oncology and the Society of Surgical Oncology found that a minimal negative margin was no different in risk factor than was a large one.

The new margin is called "no ink on tumor" - the bare minimum of cancer-free tissue is removed around the cancer cells. Quick adoption of the new guideline has resulted in the fast reduction in return surgeries.

As more surgeons adopt the guidelines, the reduction in repeat surgeries will likely continue to drop as well.



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