Guidelines Linked to Reduced Surgery After Lumpectomy for Breast Cancer Interview with:

Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan Kettering

Dr. Morrow

Monica Morrow, MD, FACS
Chief, Breast Service
Department of Surgery
Anne Burnett Windfohr Chair of Clinical Oncology
Memorial Sloan Kettering What is the background for this study?

Response: Although we know that bigger surgery does not result in better patient outcomes in breast cancer, since 2005 rates of lumpectomy have been decreasing accompanied by an increase in bilateral mastectomy for unilateral cancer.

High rates of second surgery after initial lumpectomy are one deterrent for patients. In 2013 the SSO and ASTRO developed an evidence based consensus guideline endorsing no ink on tumor as the standard negative margin width for women with stage 1 and 2 cancer having breast conserving surgery with whole breast irradiation. The purpose of our study was to examine time trends in the use of additional surgery after lumpectomy before and after guideline dissemination and to determine the impact of these trends on final rates of breast conservation. What are the main findings?

Response: Women treated between 4/13-4/15 were identified from the LA and Georgia SEER registries and surveyed. Response rate was 70%. Among the 3729 eligible patients, rates of reexcision lumpectomy decreased from 21% to 14% and conversion to mastectomy from 13% to 4% (p<.oo1) in April 2013 and April 2015 respectively. Rates of lumpectomy as final surgical procedure increased from 52% to 65% while rates of unilateral mastectomy fell from 27% to 18% and bilateral mastectomy from 21% to 16% (p=.002). What should readers take away from your report?

Response: Our findings suggest that evidence based guidelines addressing clinical controversies can be an effective low cost approach to accelerating practice change. From a practice stand point, letting patients know that application of the new guideline has reduced the need for additional surgery post lumpectomy is important. What recommendations do you have for future research as a result of this study?

Response: Further study after more time has passed is needed to determine the ultimate impact of the guideline.

No disclosures Thank you for your contribution to the community.


Morrow M, Abrahamse P, Hofer TP, Ward KC, Hamilton AS, Kurian AW, Katz SJ, Jagsi R. Trends in Reoperation After Initial Lumpectomy for Breast CancerAddressing Overtreatment in Surgical Management. JAMA Oncol.Published online June 05, 2017. doi:10.1001/jamaoncol.2017.0774

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 10, 2017 by Marie Benz MD FAAD