Guideline Change Reduces Repeat Surgeries For Women With Breast Cancer : Shots - Health News A change in guidelines for lumpectomy surgery in 2014 has already reduced the number of women undergoing additional surgery, including mastectomy, by 16 percent.
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Fewer Women Need To Undergo Repeat Surgery After Lumpectomy

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Fewer Women Need To Undergo Repeat Surgery After Lumpectomy

ROBERT SIEGEL, HOST:

For more than a decade, the number of women choosing double mastectomy has been on the rise. That's been the case even for women with early-stage breast cancer, cancer in only one breast or noninvasive breast cancer. Well, now the trend seems to be turning around. NPR's Patti Neighmond reports on the findings of a new study published in the journal JAMA Oncology.

PATTI NEIGHMOND, BYLINE: The study suggests one big reason so many women may have opted for double mastectomy. Doctors didn't agree on how wide the margin of cancer-free tissue removed along with the cancer should be. Breast cancer surgeon Monica Morrow with New York's Memorial Sloan Kettering Cancer Center.

MONICA MORROW: Was it better to have a big negative margin? Did that reduce the risk of cancer coming back? Or was a minimal negative margin fine?

NEIGHMOND: The difference of opinion led some doctors to suggest a second surgery just in case, usually when the margin between healthy tissue and cancer cells was small. And when facing a second surgery, Morrow says, many patients felt like this.

MORROW: I don't want to go through this anymore. What if you don't get a clean margin the second time? Just take it off and then I know I'll be done.

NEIGHMOND: Professional groups representing both surgeons and radiologists were concerned, so they did a major review of studies looking at whether the amount of healthy tissue removed made a difference in cancer returning. They came to a stunning conclusion.

MORROW: A minimal negative margin was just as good as a bigger negative margin at reducing the risk of cancer coming back in the future in that breast.

NEIGHMOND: The result? Guidelines published in 2014 that informed surgeons that small lumpectomy margins can be safe. Morrow was part of the group that wrote the guidelines, and she headed the new study looking at rates of second surgeries after lumpectomy before the guidelines and after. Morrow found second surgeries declined by 16 percent in patients with stage 1 and stage 2 breast cancer. A rapid and impressive change, she says, in a short period of time.

MORROW: This is a year later, so we are potentially looking at the tip of the iceberg in the sense that these were the early adopters of the guidelines. We anticipate that if we look again in another few years we may see that the number of women having lumpectomy as a final surgery has increased even more.

NEIGHMOND: In Morrow's study, the number of women choosing breast-conserving lumpectomy as their final surgery increased by 13 percent. This trend is good news for women with early-stage breast cancer, says Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. And he says it's an example of an emerging trend in medicine examining the evidence from peer-reviewed research and using it to guide medical practice.

LEN LICHTENFELD: That is, taking the science that we know, what we can actually demonstrate that works, and apply it to the care of patients. Sometimes that care is more complex and more expensive. And sometimes, frankly, we've learned that by doing less we can actually do more.

NEIGHMOND: Cancer researcher Morrow says it's important breast cancer patients don't misinterpret the findings of the study and think a second surgery is always wrong. That's not the case, she says. If there are cancer cells up against the margin of the lumpectomy, more surgery is needed. Patti Neighmond, NPR News.

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