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Breast Cancer Reexcision Rates Vary Widely

Cheryl Clark, for HealthLeaders Media, February 1, 2012

However, the issue is a ripe candidate for provider comparison because one in four women with breast cancer who undergo partial mastectomy end up having another surgery to remove more potentially impacted tissue. And, "currently there are no readily identifiable quality measures that allow for meaningful comparisons of breast cancer surgical outcomes among treating surgeons and hospitals," the researchers wrote.

The researchers said that the issue of reexcision necessity is controversial, because "there is no current consensus on the appropriate distance required for a clear margin to be deemed adequate. Although the goal of reexcision is to further reduce the risk of breast cancer recurrence and mortality, the true benefit of reexcision remains undetermined."

It's a delicate balance. The surgeon wants to get as much cancerous tissue as possible while still preserving cosmetic appearance of the breast. But how much of a clear border should exist? Opinions differ, as do the needs and characteristics of each patient.

"Failure to achieve appropriate margins at the initial operation will require additional surgery with reexcision rate estimates ranging from 30% to 60%," producing "considerable psychological, physical and economic stress for patients and delay use of recommended adjuvant therapies," they wrote.

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