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Breast Cancer Surgery Often Fails In The First Try: Most Patients Need Second Surgery
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Breast Cancer Surgery Often Fails In the First Try: Most Patients Need Second Surgery

A study published in the Journal of the American Medical Association revealed that nearly one in four women who have the minimally invasive lumpectomy surgery to treat their breast cancer are likely to need a secondary surgery, up to and including a mastectomy to remove additional cancerous cells and affected tissues. That study, performed by observing surgeries in four institutions for a five year period, found that the women typically required the second surgery after pathology reports confirmed that there were no clean margins after the first surgery.

A lumpectomy is typically done in early stage, smaller cancers and seeks to minimize the amount of breast tissue that is being removed. However, that surgery leaves the woman at a higher risk for recurrence because it is possible that cancerous cells will not be removed completely. The surgeon will send the tissue to a pathologist who will either confirm that there are clear margins (no cancer cells left at the edges of those tissues) or not.

The second surgery is not an indication that the first surgery was improperly done. In most cases, according to the study, the problem lies in a lack of basic understanding of how the breast tissue and underlying structures work. Doctors know more about the basic molecular structure of the cancer cells they are fighting than the breast, the milk ducts and other structures they are operating on. That can mean that they won't be able to find all of the cancer cells which can be inside of the milk ducts during diagnosis. Cells inside of the ducts are not visible to the doctor through mammography or MRI scans. Most breast cancer begins inside of these ducts which run from just behind the nipple to the chest wall in varying patterns.

Researchers also discovered that the testing process that is used by the pathologists are typically inadequate and may lead to subsequent diagnoses that may look like a recurrence when instead it is the original cancer that was not completely removed during the first surgery.

Before surgery, the surgeon will ask the woman what should be done if the pathology report shows that there are no clean margins or if the cancer appears to be more widespread than originally thought. Some woman will sign a form saying that they would prefer to go straight to the mastectomy in that case while others prefer to go through the lumpectomy and then reweigh their options once they recover from the surgery.


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