Statement from Inova Breast Care Center

The Journal of American Medical Association publishes results of breast cancer study, which reported that there is no agreed upon guidelines for the need of a second lumpectomy

(February 1, 2011) – Here at the Inova Breast Care Center we have always taken the issue of margin re-excision seriously, recently presenting a poster on margin re-excision at the San Antonio Breast Conference in collaboration with other leading breast centers. Our dedicated breast surgeons and the entire multi-disciplinary team have a multi-prong approach to minimizing margin re-excision.

At the time of diagnosis we use all appropriate imaging modalities including MRI to try to obtain the clearest picture of the extent of disease. Where appropriate we work with plastic surgeons to perform an immediate oncoplasty and eliminate the defect created. This has essentially eliminated positive margins by allowing us to perform a larger excision at the time of surgery and still have an excellent cosmetic outcome.

The challenge remains in women with small breasts as they are more likely to show even a small defect and in women with ductal carcinoma in situ or stage 0 breast cancer which is not as easily identified on imaging and so the extent of disease may be more difficult to identify. Our goal is always to appropriately balance the chance of returning to the operating room versus optimizing the long term cosmetic outcome. Certain devices that are not currently FDA approved show promise in reducing margin re-excision rates and we look forward to these developments.

When margins are close but inadequate we discuss with the patient and review the pathology slides at our multi-disciplinary breast conference to ensure that women are appropriately re-excised. We consider the input of our radiation oncology colleagues and what additional treatment the medical oncologist will recommend.

As disappointing as a return to the operating room is, for the majority of patient with positive margins this is necessary to have a lower recurrence rate and should be consistently performed for patient safety and quality standards.

Costanza Cocilovo, MD, Medical Director, Inova Breast Care Center

Inova Health System is a not-for-profit healthcare system based in Northern Virginia that consists of hospitals and other health services, including emergency- and urgent-care centers, home care, nursing homes, mental health and blood donor services, and wellness classes. Governed by a voluntary board of community members, Inova’s mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. Inova provides a healthy environment for its patients, families, visitors, staff and physicians by prohibiting tobacco use on its.

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