Our Summary

This research paper looks at how the approach to surgical margins for invasive breast cancer has changed due to a 2014 statement endorsing a margin of “no ink on tumor.” The study involved over 7300 women with stage I and II breast cancer, and found that the rate of surgery after initial lumpectomy (a surgery to remove the tumor and some surrounding tissue) decreased by 16% from 2013 to 2015. This decrease in surgery coincided with the release of clinical guidelines endorsing a minimal negative margin. The study suggests that this reduction in surgery can lessen the burden of surgical management in patients with cancer. It also found that surgeons who treat more than 50 breast cancer cases per year were more likely to report the margin of “no ink on tumor” as adequate compared to those treating fewer cases.

FAQs

  1. What change in the approach to surgical margins for invasive breast cancer was made in 2014?
  2. How did the release of clinical guidelines endorsing a minimal negative margin affect the rate of surgery after initial lumpectomy?
  3. What does the study suggest about the correlation between the number of breast cancer cases a surgeon treats per year and their likelihood to report the margin of “no ink on tumor” as adequate?

Doctor’s Tip

A helpful tip a doctor might give a patient about lumpectomy is to follow post-operative care instructions carefully to promote proper healing and reduce the risk of complications. This may include keeping the incision site clean and dry, avoiding strenuous activities that could strain the surgical site, and attending follow-up appointments to monitor healing and ensure the success of the procedure. Additionally, the doctor may recommend maintaining a healthy lifestyle, including regular exercise and a balanced diet, to support overall health and aid in recovery.

Suitable For

Patients who are typically recommended for lumpectomy include those with early-stage breast cancer (stage I and II), as well as those with small tumors that can be easily removed with clear margins. Lumpectomy may also be recommended for patients who wish to preserve their breast and avoid mastectomy, as well as those who are not suitable candidates for mastectomy due to other health conditions. Additionally, lumpectomy may be recommended for patients who have undergone neoadjuvant therapy (chemotherapy or hormone therapy before surgery) and have had a good response, making breast-conserving surgery a feasible option.

Timeline

Before lumpectomy:

  1. Patient undergoes diagnostic tests such as mammograms, ultrasounds, and biopsies to confirm the presence of breast cancer.
  2. Patient meets with their healthcare team to discuss treatment options, including lumpectomy.
  3. Patient may undergo pre-operative tests and evaluations to ensure they are healthy enough for surgery.

During lumpectomy:

  1. Patient undergoes surgery to remove the tumor and a small amount of surrounding tissue.
  2. The surgery is usually performed under general anesthesia and can take a few hours to complete.
  3. The removed tissue is sent to a pathology lab for analysis to determine if the margins are clear of cancer cells.
  4. Some patients may also have lymph nodes removed for further analysis.

After lumpectomy:

  1. Patient may experience pain, swelling, and bruising at the surgical site.
  2. Patient may need to wear a supportive bra and avoid strenuous activities for a period of time.
  3. Patient may need to undergo radiation therapy to ensure all cancer cells are destroyed.
  4. Patient will have regular follow-up appointments with their healthcare team to monitor their recovery and check for any signs of cancer recurrence.
  5. Patient may undergo additional treatments such as chemotherapy or hormone therapy depending on the characteristics of their cancer.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumpectomy include:

  1. What are the benefits of undergoing a lumpectomy compared to other treatment options for my specific situation?
  2. What are the potential risks and complications associated with a lumpectomy?
  3. How much tissue will be removed during the lumpectomy procedure?
  4. What is the expected recovery time after a lumpectomy?
  5. Will I need any additional treatments, such as radiation therapy or chemotherapy, after the lumpectomy?
  6. What are the chances of the cancer recurring after a lumpectomy?
  7. How often will I need follow-up appointments and imaging tests after the lumpectomy?
  8. Are there any lifestyle changes or precautions I should take after the lumpectomy to reduce the risk of cancer recurrence?
  9. Can you explain the concept of a “no ink on tumor” margin and how it applies to my specific case?
  10. How many lumpectomy procedures have you performed, and what is your experience and success rate with this type of surgery?

Reference

Authors: Morrow M, Abrahamse P, Hofer TP, Ward KC, Hamilton AS, Kurian AW, Katz SJ, Jagsi R. Journal: JAMA Oncol. 2017 Oct 1;3(10):1352-1357. doi: 10.1001/jamaoncol.2017.0774. PMID: 28586788