Lumpectomies can lead to repeat surgeries

There's important new research out about breast cancer.

A study in the Journal of the American Medical Association found almost a quarter of the women who got a lumpectomy went back for more surgery. That may not have been necessary.

CBS News correspondent Elaine Quijano reports that when Donna Marano learned she had breast cancer in 2008, she chose a lumpectomy to remove her tumor and preserve as much of her breast as possible. Just one month later she had to undergo a second procedure.

"We didn't believe there was any more cancer cells, but to be safe, decided to go in and remove it," Marano said.

Today's study showed that nearly one out of four breast cancer patients had the same experience as Marano. It also raises questions about whether some of these procedures are necessary. Dr. Laurence McCahill led the study, and says there is no standard guideline for when there should be a follow up procedure.

"Is lumpectomy and the decision for a second operation fairly uniform across the country? We found that it wasn't, that there's quite a lot of variability from hospital to hospital and also among individual surgeons," McCahill said.

During a lumpectomy, surgeons try to remove the entire tumor and the cells surrounding it to get what's called a "clean margin." That means there are no cancer cells in the tissue surrounding the tumor. Researchers studied more than 2,200 women who had lumpectomies, and the criteria for re-operation differed dramatically: 48 percent of women with a clean margin within one millimeter around the tumor still had repeat surgeries; 20 percent had a margin of up to two millimeters and were still re-operated on.

With no set guidelines the decision to re-operate comes down to each surgeon. Dr. McCahill says their competence and level of experience vary greatly, and that the very idea of having a second surgery has serious consequences.

"Sometimes women are frustrated enough by a second operation that a percentage of them, maybe half, will just elect to move forward with a mastectomy or a removal of the whole breast," McCahill said.

Perhaps more disturbing, 14 percent in the study showed evidence of cancer left behind after the first surgery, but didn't go in for a second procedure.

[janientexas]

In November 2007 I had 2 lumpectomies done 11 days apart. The surgeon told me they got the non invasive cancer the first time but the path report came back a few days later and they found the invasive cancer. So I had the second lumpectomy done. It saved my life. I then did chemo and radiation. It has been 4 years and I am still cancer free.

[Jaylah54]

Sure sounds like doctor insurance fraud to me. Why would any woman go back for a second surgery if the pathology report came back showing clean margins?

In my own case, my surgeon was a very quiet, no-nonsense sort of a guy yet, when I went back for my post surgical check-up and he found it I had clean margins, he pumped his fist and said, "YESSSS!"

Seems to me a responsible, reputable surgeon would want to help a woman keep her breast if doing so didn't compromise her health.

I guess it all comes down to patient education. Women (and men, too, for that matter) who undergo a lumpectomy for breast cancer which pathology then comes back with report of clean margins, and whose doctors then start talking about a second surgery, really need to ask their doctor, "WHY?" And unless he comes up with a damned good answer (and not just some lame thing like, "Well, just to make sure....") they need to find a different doctor.