Here's an outrageous statistic. Did you know that when a woman goes in to have a breast cancer lump removed there is a 15-40% chance that the surgeons will miss part of it? That means that they will have to go in a second time to get the job done completely. The good news is a new procedure developed at Mayo Clinic might be able to dramatically reduce the chance of a re-do to 3%.
When a woman has a breast-cancer mass removed, the procedure is called a lumpectomy. That means that the entire breast is not removed as in a mastectomy. Instead only the lump is removed. Of course, when the surgeon performs a lumpectomy, he does the best he can to limit the amount of normal breast tissue that's removed along with the cancer. That leaves the possibility that he might not get all of the cancer out.
When the operation is over, the surgeon sends the tumor specimen to the pathologist for a microscopic examination. One of the first things the pathologist does is to see if all the edges of the removed tumor are free of cancer. If they show no tumor cells at the edges, that means that the cancer was completely removed and the surgery was a success.
However, if the edges of the tumor show cancer cells the likelihood is that there is still some cancer left in the breast. And, in that case, the woman will have to go in for another surgery to clean the remaining cancer out. Depending on who the surgeon is and where the woman has the surgery, there is up to a 40% chance of this happening. But the doctors at Mayo Clinic are now doing it differently. Here's what they do.
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After the surgeon removes the tumor, it is instantly frozen and then sent immediately to the pathologist. And while the patient is still on the operating table, the pathologist takes about 20-30 minutes to determine if the edges are free of cancer. If they are, he calls the surgeon and tells him the operation is a success. If they aren't, the surgeon can then immediately go back and clean out whatever edges the pathologist determined still has some cancer. With this type of aggressive analysis during surgery, the Mayo docs have been able to reduce the need for a repeat surgery down to 3%.
Unfortunately, this common sense approach is not available at all hospitals. That's because it's too labor intensive for some less well-equipped hospitals. So if you're a woman facing the need for a lumpectomy, you might want to make a few calls to see where you can get this new procedure done. It just might save you a repeat trip to the operating table.
Yours for better health,
Frank Shallenberger, MD
Boughey JC, Hieken TJ, Jakub JW, et al. Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: Evaluation of the National Surgical Quality Improvement Program data. Surgery. 2014 Jul;156(1):190-7.