WCAX.COM Local Vermont News, Weather and Sports-Vermont research on treating breast cancer

When women are diagnosed with early stage breast cancer, the vast majority choose breast conserving therapy-- a partial mastectomy to remove the tumor. But according to a study recently published in the Journal of American Medicine, 30-60 percent of those patients undergo more surgery-- re-excisions-- because not all of the microscopic cancer cells were removed the first time.

"One of the banes of trying to do a lumpectomy procedure is you need to try to remove the cancer, but also have a rim of normal tissue around it, so you make sure that you remove it all. The problem is that in order to do that you have to look at the specimen under the microscope and that whole process takes a few days," said Dr. Ted James, a surgical oncologist at UVM-FAHC.

A total of 2,206 patients and 54 surgeons from four sites were part of the study, the majority from the University of Vermont, where the study was initiated and more than 1,000 Fletcher Allen Health Care patients participated. The results showed significant variations in re-excision rates from one doctor to the next. For example, some patients had a 60 percent chance of needing more surgery with some doctors over others. The re-excision rate at Fletcher Allen hovers around 15 percent.

"It was an interesting find and we always knew that there would be a little bit of variation in terms of what a surgeon would find as the appropriate criteria, but the variation, as you said, is quite drastic and I think it really has a lot to say about. We need a consensus in terms of what is an adequate margin. How much is enough? And that way we can try to rein in some of that variation," James said.

Right now there is no consensus. Doctors use different technologies, different imaging and different measures when removing tumors. James says the next step is finding a "standard of care."

"And that's really what this study had highlighted," he said, "that there isn't a standard of care and that's why we're seeing this wide variation in terms of how different surgeons interpret the data and interpret the pathology report. So I think what this really shed light on is the fact that we need to do further research to find out what are the optimal metrics, what are the optimal margins for a lumpectomy."

And that, James says, will reduce the number of repeat surgeries and the variation from doctor to doctor. The ultimate goal: improved care for women with early stage breast cancer-- physically, financially and psychologically.

James says each patient at FAHC is reviewed by all of the surgeons, oncologists, radiologists and pathologists to determine the best course of treatment. They see about 300 new cases of breast cancer each year.