Syracuse (WSYR-TV) -- After a breast cancer diagnosis the most common operation is breast conserving therapy or partial mastectomy. The goal is to surgically remove all the cancer and leave behind normal tissue – what’s known as clear margins. Failure to attain these margins requires additional surgery. A new study looked at how re-operation rates can vary from hospital to hospital and surgeon to surgeon.
Judy Herrick remembers what went through her mind after being diagnosed last year with breast cancer.
"The diagnosis was invasive ductal carcinoma and I have to say the word invasive was more frightening to me than the word carcinoma because there is no way in that initial diagnosis to indicate how invasive that really is,” said Herrick.
Herrick underwent surgery to remove the cancer.
“The goal of the surgeon is to excise the cancer with just a little bit, a small rim of normal tissue around the cancer and that's called your margin,” said Doctor Laurence E. McCahill, with St. Mary's Health Care in Grand Rapids, Michigan.
If margins aren’t clear of cancer or wide enough, a second operation may be recommended.
"I went in with the notion that I may have to have a second surgery,” Herrick said.
Herrick did have a second surgery and it was successful.
Dr. McCahill co-authored a study on the re-excision or re-operation rates of more than 2,200 women. Participants underwent a partial mastectomy as their first operation at four health systems around the country.
"The range of re-excisions do not appear to be completely explained by the patient or tumor characteristics,” Dr. McCahill said.
Researchers compared second surgery rates from surgeon to surgeon and hospital to hospital. The study appears in this week’s JAMA, Journal of the American Medical Association.
"The variation in re-excision rates among surgeon range from zero percent all the way up to 70 percent,” Dr. McCahill continued.
Researchers say there is no set guideline for re-operations.
"We evaluated the practice patterns of 52 different surgeons and there is really a great degree of variation in the care you receive by whom you choose to see,” said Dr. McCahill.
Herrick chronicled her breast cancer journey in a book. Her last mammogram came back clean and clear, but there’s one more milestone she is waiting to conquer.
“I think for any of us who have gone through the diagnosis of cancer of any kind we always strive towards that five years, that is the pivotal point to say that I have gone through this and I am on the other side,” Herrick said.
Researchers also found nine percent of women who require a second surgery undergo a total mastectomy.
