No Clear Guidelines for Breast Cancer Surgery

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The NY Times published an article today that is quite disturbing. The Times reports on a recent study published in The Journal for the American Medical Association that reveals that there are no clear guidelines when it comes to opting for breast cancer surgery. The study found that in some instances, surgery was not indicated or effective even though it was performed.
“Nearly half of women who had lumpectomies for breast cancer had second operations they may not have needed because surgeons have been unable to agree on guidelines for the most common operation for breast cancer, a new study finds. It also hints that some women who might benefit from further surgery may be missing out on it. Rates of repeat surgery can vary widely by doctor, from zero percent to 70 percent, according to the study. The additional operations are done when pathology reports on tumor specimens suggest that the first operation may have left behind some cancer cells. But surgeons differ when it comes to interpreting those reports.”
Such lack of clarity may lead to unnecessary operations in some breast cancer cases and in other cases, lack of surgical intervention when surgery would improve the chances of breast cancer survival.
According to the Times, “Nearly half of the repeat operations were done in women whose pathology reports did not indicate that any stray cancer cells had been left behind, meaning that the operations probably did not help the patients. In more disturbing findings, 14 percent of patients who did have evidence of cancer left behind did not have another operation, for unknown reasons.
Rates of repeat surgery varied by surgeon, and by hospital, from 1.7 percent to 20.9 percent. Differences in the patients did not account for most of the variation, though very thin women, who tend to have small breasts, were more likely to need second operations. Surgeons say that is because they try to remove as little tissue as possible from small breasts for cosmetic reasons.
“The number of operations women undergo definitely depends on where you’re treated, and even to a greater level on which surgeon you see,” Dr. McCahill said. “We put the math behind it and said, this is a lot of second operations that maybe don’t make a difference.”

Eva Bleich
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