How a Change to Breast Cancer Surgery Might Help Patients

Breast cancer patients were less likely to need second surgery when more tissue was removed during partial mastectomy

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When it comes to breast cancer surgery, a slightly wider scope may lead to better outcomes for patients.

Removing more breast tissue during partial mastectomies might make breast cancer patients less likely to need a second surgery to remove their cancer, a new study found.

For the more than 150,000 US breast cancer patients who undergo a partial mastectomy each year, this finding could improve health outcomes.

According to a Yale University press release, 20 to 40 percent of breast cancer patients may have cancer cells near the edge of the tissue that the surgeon removes during partial mastectomy. These remaining cells are called positive margins. This means these patients' breast cancer could be more likely to come back — possibly making a second surgery necessary.

A partial mastectomy, sometimes known as a lumpectomy, is a type of breast cancer surgery that removes only a part of the breast. According to the American Cancer Society, the margins of a tumor can be described as positive (cancer cells extend out to the edge of the tissue), negative (no cancer cells are found in the tissue) or close (any situation that falls between positive and negative).

"Despite their best efforts, surgeons could not predict where the cancer was close to the edge," said lead study author Anees B. Chagpar, MD, associate professor of oncology surgery at Yale School of Medicine and director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven, in a press release.

But when surgeons removed more tissue all the way around the site of the breast cancer tumor — known as cavity shave margins — patients were less likely to be left with positive margins.

"Taking cavity shave margins cut the positive margin rate in half, without compromising cosmetic outcome or increasing complication rates," Dr. Chagpar said.

Dr. Chagpar and team reached their conclusions after studying 235 breast cancer patients who underwent partial mastectomy. After this surgery, patients were randomly assigned to have additional tissue removed or not. These patients ranged in age from 33 to 94, with a median age of 61.

Among the patients who had no additional tissue removed, 33.6 percent had positive margins after their partial mastectomy. For those who did have additional tissue around the tumor site removed, that figure was only 19.3 percent — meaning they may have been less likely to require additional breast cancer surgery.

"This randomized controlled trial has the potential to have a huge impact for breast cancer patients," Dr. Chagpar said. "No one likes going back to the operating room, especially not the patients who face the emotional burden of another surgery."

This study was published May 30 in The New England Journal of Medicine.

The Yale Cancer Center funded this research. Conflict of interest disclosures were not available at the time of publication.

Review Date: 
May 29, 2015
Last Updated:
June 3, 2015