Almost half of women who had lumpectomies for breast cancer were the work of the second can not be required because the surgeons were unable to agree on guidelines for the most common operation for breast cancer, a new study Notes. It also hints that some women who could benefit from further surgery may be missing it. The surgery recurrence rates can vary significantly from the doctor, from zero percent to 70 percent, according to the study.
Additional work is carried out when pathology reports on tumor samples show that the first operation may have left behind some cancer cells. But surgeons differ when it comes to interpreting these reports.
The uncertainty about the operation of a cancer that was in use for 30 years is "shameful," said Dr. Laurence E. McCahill, first author of the study and director surgeon and his assistant Lacks Cancer Center in Grand Rapids, Mich. Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in New York, said the study and attention by the public can help boost business groups to develop guidelines for surgeons. The details of the surgery is not organized, but surgeons generally follow expert advice.
"It's getting to be time for leaders in radiation oncology and surgery to get together and make a statement of consensus that could help to guide their members," Dr. Morrow said.
The study by Dr. McCahill, published online Tuesday by the Journal of American Medical Association, based on medical records of 2,206 women who had lumpectomies in one of four hospitals in different parts of the country. Above all, 22.9 percent had more than one function.
Almost half of the operations were repeated in women whose pathology reports did not indicate that any stray cancer cells were left behind, which means that the work probably did not help patients. In most disturbing findings, 14 percent of patients had evidence of cancer left behind had no business, for unknown reasons.
The rates of repeat surgery varied by surgeon, and from hospitals, from 1.7 percent to 20.9 percent. Differences in patients is not caused much change, although very thin women, who tend to have small breasts were more likely to need the work of the second. The surgeons say it is because they try to remove as little tissue as possible from small breasts for cosmetic reasons.
"The number of business women are definitely depends on where you are treated, even at higher level at which surgeon you see," Dr. McCahill said. "We put the math behind it and said, this is a very work that the second might not make a difference."
Dr. McCahill said that such a high repeat function does not occur in other forms of cancer surgery, partly because surgeons do not try to spare tissue for aesthetic reasons, such as a lumpectomy.
One major reason for the difference in repeat business after lumpectomy is that there is no consensus among surgeons about how big the rim or "margin" of healthy tissue should be taken out when the cancer is removed. The surgeons are trying to cut net around a tumor and remove a sufficient margin to ensure that the cancer is removed.
Or negative net margins in general, the entire tumor was removed. Positive margins indicate any cancer was probably left behind and the other work is necessary to prevent recurrence.
But how great must be the room? When the tumor and healthy tissue removed from the surface of the entire sample is impregnated, so that when it is sliced and viewed through a microscope, the pathologist can use the signals ink to find room between cancer and healthy tissue and measure how close the cancer cells.
Some doctors believe the operation is not complete if the cancer cells are touching ink. Others want a wider margin of healthy tissue between cancer cells and ink: one, two or even five millimeters. If there is less operate again.
The surgeons say some radiation oncologists and medical insist on a certain size room before the rest of the patient's treatment. The decision to reoperate also depends in part on the type tumor of the patient. But there is no indication that a margin greater than any "do not contact ink" affect cancer recurrence or survival, said Dr. Morrow, who wrote an editorial accompanying the study. In the hospital said, "do not contact ink" is generally considered quite good.
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Tuesday, January 31, 2012
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