BOSTON (CBS) – A local doctor is taking a look at the controversy over the size of tissue margins in breast cancer tumor surgery.
Dr. Stuart Schnitt of Beth Israel Deaconess Medical Center and Harvard Medical School is calling on the medical community to looks closely at this and to find standardization, when possible.
Dr. Schnitt co-wrote an article that appeared Thursday in the New England Journal of Medicine discussing the controversy over the size of tissue margins in breast cancer tumor surgery.
”My co-authors and I have been under the impression from our clinical experience that there are too many patients who undergo additional second surgeries or re-excisions following their initial lumpectomy,” he said.
Dr. Schnitt says the driving force behind his questions is that many clinicians have determined that some arbitrary rim of normal tissue needs to be taken out of the breast.
On most surgeries, there is a standard 2-5mm rim of tissue that is taken out along with the tumor.
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Complications from this can often land patients back in the hospital for a second surgery.
“There are certain patients who probably need bigger excisions, but to say as a standard everybody who has a lumpectomy has to have a 2-5mm rim of normal tissue taken out is probably not correct,”
Dr. Schnitt said. “And by thinking that way, a lot of woman get unnecessary additional surgery which costs not only the patients but the healthcare system in general”
He says that this kind of standardization comes from thinking in the early days of breast conserving therapy.
“Now, most patients who have breast cancer get treated not only in the breast but they get systemic therapy either with hormonal therapy or chemotherapy,” said Dr. Schnitt. “And the combination of lumpectomy and radiation therapy in the breast and systemic therapy provides lower local (tumor) recurrence rates than in the past when patients just got lumpectomy and radiation therapy without systemic therapy.”