Re-excision or not?

Anonymous

As I've mentioned in other threads, I'm asking some of these questions about my sister's cancer, not mine.

She was scheduled for Re-excision today but it's been delayed for about 12 days because she's been sick.

I've been doing some research and found this article, which I hope someone can help me understand.

Published online 2018 Feb 8, Re-excision and survival following breast conserving surgery ..., it says "Patients who were treated with BCS plus re-excision surgery with either mastectomy or further BCS had similar all-cause and breast cancer-specific mortality as those treated with BCS without re-excision.

"These results suggest that breast cancer patients who are treated with BCS plus re-excision surgery by either mastectomy or further BCS have similar survival as those treated with BCS without re-excision. The significant variation in the likelihood of re-excision by geography and by individual surgeon is concerning, especially given the costs to the patient associated with additional surgery and the financial costs to the health system."

Am I misunderstanding, but does this study mean that the mortality rate isn't improved if you have a re-excision?

Thank you.

Jtjjc5

That is a great question, as I am facing this very dilemma. My margins were 1mm and not 2mm; my surgeon wants to do a re-excision, so I’m interested in what others might have to say on the topic.

Anonymous

Hi Jtjjc5,

Below is a reply that I received in a private message. Seems I may have misunderstood. Sometimes easy to do because the subject of cancer is broad and, at times, quite difficult to understand including all the terminology (at least for me).

I sincerely appreciate the reply and hope it helps.

"... that the survival advantage of a lumpectomy + rads (versus a MX) remains even if a re-excision is required after the initial lumpectomy. One might expect that if a re-excision is required, the survival rate might be lower, because the cancer was larger or more spread out than expected. But having a re-excision successfully brings survival rates back up to what would be expected for a lumpectomy + rads, in cases where a re-excision was not required.

"The explanation is right at the start of the report:

"Increasing population-based evidence suggests that patients who receive breast conserving surgery (BCS) plus radiotherapy have superior survival than those who receive mastectomy. It is unclear, however,how BCS followed by re-excision is associated with all-cause and breast cancer-specific mortality, and whether the BCS survival advantage is maintained if re-excision is needed.

"And in the discussion section:

"In this study, breast cancer patients who were treated with BCS plus re-excision surgery had similar all-cause and breast cancer-specific mortality as those treated with BCS without re-excision. These results supplement increasing observational evidence that in the population-based context, patients who receive mastectomy have poorer survival than those who receive BCS plus radiotherapy, suggesting that this survival advantage may extend to patients who receive re-excision surgery by either mastectomy or further BCS.

"My conclusion: Not having a re-excision, when one is called for because of close margins, is likely to lead to a greater recurrence risk and possibly a higher mortality rate. Having the re-excision provides results survival rates equal to what they would have been if the margins after the initial lumpectomy had never been close in the first place."

Jtjjc5

Hi Viewfinder,

Thank you for the information, it makes sense and is similar to what the radiologist said with regard to lumpectomy w/radiation vs. mastectomy. With the original surgery a seed was inserted during the biopsy, when I went in for the surgery two needle locs were used as the radiologist reviewing the mammogram on that day found another small area of calcification further to the right of the original, I am thinking it was a guessing game as far as where to cut-basically, that is what the BCS said, 'she can't see it she's using the tools provided as guidance'. Hopefully, now that she has the pathology report she has a better idea. I don't have a lot of breast to work with (34B), but want to make clear to her to take out more than what she thinks she needs.

Great information, thank you!

Anonymous

Jtjjc5, I wish you all the very best!