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Pick Your Breast Cancer Surgeon Very Carefully

January 4, 2011
Written by: , Filed in: Breast Imaging
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Rates of DCIS breast cancer recurrence after breast-conserving surgery (BCS) could be reduced by 15 percent to 30 percent if surgeons removed wider margins of tissue around the tumor and used radiation therapy more often, according to a new study published this week in the Journal of the National Cancer Institute.

Andrew W. Dick, PhD, of the RAND Corporation and colleagues conducted a retrospective study of women diagnosed with ductal carcinoma in situ from 1985 through 2000. They used the tumor registries of Monroe County, New York (the Rochester area), and the Henry Ford Health System in Detroit.

The researchers checked, among other things, the rate of ipsilateral (same breast) recurrence, the type of treatment (mastectomy or breast-conserving surgery, radiation therapy or not), and the margin of tissue surrounding the excised tumors. They defined the margin as positive (cancer cells extended to the edge of the resected tissue), negative (cancer cells were more than 2 millimeters from the edge), or close (cancer cells were within 2 millimeters of the edge).

The researchers found that the two most important determinants of whether cancer would recur were the size of the margins and the use of radiation therapy—choices either made or significantly influenced by the physician, as is the choice of opting for mastectomy or BCS. “BCS in the absence of radiation therapy resulted in substantially lower isilateral event-free survival than either BCS followed by radiation therapy or mastectomy,” the authors wrote.

They added: “Regardless of treatments, positive or close margins following the last surgical treatment substantially compromised ipsilateral event-free survival.”

An accompanying JNCI editorial by Beth A. Virnig, PhD, and Todd M. Tuttle, MD, of the University of Minnesota notes that the findings pose a problem for patients: how do you discover the relevant information about a potential surgeon? Drs. Virnig and Tuttle wrote:

How should women select a provider knowing that up to 35 percent of the variation in outcomes is based on their choice of physician but that there are no actionable characteristics that can be taken into account?

The authors suggest that recurrence and positive-margin scores of physicians in a particular area be published. However, they concede that it doesn’t seem likely that providing information about all of the variables for all physicians “in a way would guide action for the general public could be easily achieved.”

Related seminar: Breast & Women’s Imaging Seminar

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