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New Guideline Provides Recommendations for Breast Cancer Surgeons

BOSTON – Over the past 20 years, rigorous clinical trials have demonstrated that lumpectomy followed by radiation therapy is as effective as mastectomy for the treatment of breast cancer, providing female patients with a breast-conserving treatment option. During lumpectomy, surgeons remove both the primary tumor and a rim of normal tissue surrounding the tumor, referred to as the “surgical margin.”

But the question of what constitutes an adequate margin – how much normal tissue needs to be removed to reduce the risk of cancer recurrence in the breast – has remained controversial. Now, a new guideline (http://www.surgonc.org/margins-study) jointly developed by the Society of Surgical Oncology (SSO) and the American Society of Radiation Oncology (ASTRO), provides physicians with an evidence-based surgical treatment path to follow, and advises against the routine removal of larger amounts of healthy breast tissue.

Stuart Schnitt, MD, Director of Anatomic Pathology at Beth Israel Deaconess Medical Center (BIDMC) was one of 12 national leaders from the fields of surgical oncology, pathology, radiation oncology, medical oncology, and patient advocacy, convened by SSO and ASTRO to develop the new guideline.

“There has been no agreement among surgeons or radiation oncologists as to what constitutes the ideal margin width in patients with invasive breast cancer who undergo breast-conserving treatment,”explains Schnitt, who has written about this issue in The New England Journal of Medicine. “Until now there hasn’t been a sufficiently strong evidence base on which to make a decision.” As a result, roughly 25 percent of breast cancer patients who undergo lumpectomy will go on to have a re-excision, a second surgery that is conducted to ensure that enough normal tissue surrounding the tumor – the margin – has been removed to prevent cancer recurrence.

The new consensus guideline was recently published simultaneously in the Annals of Surgical Oncology, the Journal of Clinical Oncology and the International Journal of Radiation Oncology, Biology, Physics. An editorial accompanying the publication of the guideline in the radiation oncology journal states, “This guideline statement has the potential to substantially reduce the number of operations required of patients who pursue breast-conserving therapy, thereby reducing both cost and burden, and perhaps also improving ultimate cosmetic outcomes.”

“In current clinical practice where almost all patients who undergo breast conserving therapy also receive some type of systemic therapy [chemotherapy, hormonal therapy, or both] local recurrence rates are remarkably low and for most patients, a very narrow margin of normal tissue around the tumor appears to be adequate,” explains Schnitt. “This new guideline should be practice-changing and spare many patients from having unnecessary second operations.”

The consensus panel examined the findings of a comprehensive review of 33 research studies which, in total, encompassed 28,162 patients with stage I or stage II invasive breast cancer.

“In the end, our review of the data did not support the routine removal of larger amounts of healthy breast tissue, beyond having no cancerous cells touching the edge of the lumpectomy specimen,” says Schnitt, “If this guideline is followed, far fewer patients with breast cancer who chose the breast-conserving approach will be taken back to the operating room for second operations [re-excisions] to remove additional breast tissue.”

The new guideline was produced with a grant from Susan G. Komen and is endorsed by the American Society of Clinical Oncology (ASCO) and the American Society of Breast Surgeons (ASBS).

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide.

The BIDMC health care team includes Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, Signature Health Care, Commonwealth Hematology-Oncology, Beth Israel Deaconess HealthCare, Community Care Alliance, and Atrius Health. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew Senior Life and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

BIDMC Contact: Bonnie Prescott
    Phone: (617) 667-7306
    Email: [email protected]

BIDMC’s Stuart Schnitt, MD, is a member of national consensus panel outlining a new treatment path for patients following lumpectomy

  • Date: 2/18/2014
  • BIDMC Contact: Bonnie Prescott
  • Phone: (617) 667-7306
  • Email: [email protected]

BOSTON – Over the past 20 years, rigorous clinical trials have demonstrated that lumpectomy followed by radiation therapy is as effective as mastectomy for the treatment of breast cancer, providing female patients with a breast-conserving treatment option. During lumpectomy, surgeons remove both the primary tumor and a rim of normal tissue surrounding the tumor, referred to as the “surgical margin.”

But the question of what constitutes an adequate margin – how much normal tissue needs to be removed to reduce the risk of cancer recurrence in the breast – has remained controversial. Now, a new guideline (http://www.surgonc.org/margins-study) jointly developed by the Society of Surgical Oncology (SSO) and the American Society of Radiation Oncology (ASTRO), provides physicians with an evidence-based surgical treatment path to follow, and advises against the routine removal of larger amounts of healthy breast tissue.

Stuart Schnitt, MD, Director of Anatomic Pathology at Beth Israel Deaconess Medical Center (BIDMC) was one of 12 national leaders from the fields of surgical oncology, pathology, radiation oncology, medical oncology, and patient advocacy, convened by SSO and ASTRO to develop the new guideline.

“There has been no agreement among surgeons or radiation oncologists as to what constitutes the ideal margin width in patients with invasive breast cancer who undergo breast-conserving treatment,”explains Schnitt, who has written about this issue in The New England Journal of Medicine. “Until now there hasn’t been a sufficiently strong evidence base on which to make a decision.” As a result, roughly 25 percent of breast cancer patients who undergo lumpectomy will go on to have a re-excision, a second surgery that is conducted to ensure that enough normal tissue surrounding the tumor – the margin – has been removed to prevent cancer recurrence.

The new consensus guideline was recently published simultaneously in the Annals of Surgical Oncology, the Journal of Clinical Oncology and the International Journal of Radiation Oncology, Biology, Physics. An editorial accompanying the publication of the guideline in the radiation oncology journal states, “This guideline statement has the potential to substantially reduce the number of operations required of patients who pursue breast-conserving therapy, thereby reducing both cost and burden, and perhaps also improving ultimate cosmetic outcomes.”

“In current clinical practice where almost all patients who undergo breast conserving therapy also receive some type of systemic therapy [chemotherapy, hormonal therapy, or both] local recurrence rates are remarkably low and for most patients, a very narrow margin of normal tissue around the tumor appears to be adequate,” explains Schnitt. “This new guideline should be practice-changing and spare many patients from having unnecessary second operations.”

The consensus panel examined the findings of a comprehensive review of 33 research studies which, in total, encompassed 28,162 patients with stage I or stage II invasive breast cancer.

“In the end, our review of the data did not support the routine removal of larger amounts of healthy breast tissue, beyond having no cancerous cells touching the edge of the lumpectomy specimen,” says Schnitt, “If this guideline is followed, far fewer patients with breast cancer who chose the breast-conserving approach will be taken back to the operating room for second operations [re-excisions] to remove additional breast tissue.”

The new guideline was produced with a grant from Susan G. Komen and is endorsed by the American Society of Clinical Oncology (ASCO) and the American Society of Breast Surgeons (ASBS).

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide.

The BIDMC health care team includes Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, Signature Health Care, Commonwealth Hematology-Oncology, Beth Israel Deaconess HealthCare, Community Care Alliance, and Atrius Health. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew Senior Life and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

– See more at: http://bidmc.org/News/In-Research/2014/February/Schnitt.aspx#sthash.Qe4l6Mp3.dpuf


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