ASCO 2015: Removing More Breast Tissue Reduces by Half the Need for Second Cancer Surgery
Removing more tissue during a partial mastectomy could spare thousands of breast cancer patients a second surgery, according to a Yale Cancer Center study. The findings were presented May 30 at the 2015 ASCO Annual Meeting (Abstract 1012) in Chicago and simultaneously published by Chagpar et al in The New England Journal of Medicine.
Nearly 300,000 women in the United States are diagnosed with breast cancer each year; more than half undergo breast-conserving surgery with a partial mastectomy to remove the disease. However, between 20% and 40% of patients who undergo this procedure have positive margins, the presence of which often leads to a second surgery to ensure that no cancer remains. This study explored how removing more tissue all the way around the tumor site—known as cavity shave margins—could reduce the need for a second surgery.
Study Findings
In this study of 235 patients with breast cancer ranging from stage 0 to stage III, surgeons performed a partial mastectomy as they normally would. Patients were then randomly assigned in the operating room to either have additional cavity shave margins removed or not. Patients in the study will be followed for 5 years to evaluate the impact of the technique on recurrence rates.
Before randomization, the rate of positive margins after partial mastectomy was similar in both the “shave” and “no-shave” groups (36% and 34%, respectively). Having cavity shave margins resected significantly lowered the rate of positive margins (19% vs 34% in the no-shave group), and also led to a lower rate of second surgery for margin clearance (10% vs 21%).
“Despite their best efforts, surgeons could not predict where the cancer was close to the edge,” said the study's lead author, Anees Chagpar, MD, MSc, MA, MPH, MBA, FRCS(C), FACS, Associate Professor of Surgery (Oncology) at Yale School of Medicine and Director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven. “Taking cavity shave margins cut the positive margin rate in half, without compromising cosmetic outcome or increasing complication rates.”
“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.”
Dr. Chagpar is the corresponding author for the The New England Journal of Medicine article.
The study was sponsored by Yale University. For full disclosures of the study authors, view the study abstract at abstract.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
