Unclear Surgery Rules Lead to Multiple Operations for Breast Cancer
Posted by: Salvatore J. Zambri, founding member and partner
According to a recent article in the New York Times, inconsistent guidelines are prevalent among radiology oncologists and breast cancer surgeons. "Nearly half of women who had lumpectomies for breast cancer had second operations they may not have needed because surgeons have been unable to agree on guidelines for the most common operation for breast cancer, a new study finds. It also hints that some women who might benefit from further surgery may be missing out on it."
Dr. Laurence Cahill, author of the study, surgeon and assistant director of the Lacks Cancer Center in Grand Rapids, Michigan and Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in New York, concluded that a consensus statement needs to be made by the leaders in oncology radiation and surgery. Close to half of the repeat operations were performed on women whose pathology reports indicated that no cancer cells were left behind after the first surgery while 14% of the patients who did have cancer left behind did not have a second operation. Repeat surgery rates range from 0% to 70% and can vary widely by doctor. However, a doctor's repeat rate is not necessarily the best indicator of whether the original operation was done correctly, as the surgeon may have performed more mastectomies than lumpectomies or could have neglected to operate a second time, even when it was needed.
After a lumpectomy, the most common operation for breast cancer, nearly all patients receive additional radiation and systemic treatment with chemotherapy or hormones to decrease the recurrence rate and margin size concerns. Questions remain as to the margin necessary between cancer cells and healthy tissue. Until those questions can be answered and surgeons come to a consensus, many women will continue to either have a potentially unnecessary second surgery or miss one when it is needed. Both of these unsatisfactory options add more physical and mental stress for patients.
About the author:
Mr. Zambri is a Board-Certified Civil Trial Attorney and Past-President of the Trial Lawyers Association of Metropolitan Washington, D.C. The association has recently named him the " 2011 Trial Lawyer of the Year". He has also been acknowledged by Washingtonian magazine as a "Big Gun" and among the "top 1%" of all of the more than 80,000 lawyers in the Washington metropolitan area. The magazine also acknowledged him as "one of Washington's best--most honest and effective lawyers" who specializes in medical malpractice matters, product liability claims, and serious automobile accident claims. Mr. Zambri was recently (2011 edition) acknowledged as one of the "Best Lawyers in America" by Best Lawyers, and has also been repeatedly named a "Super Lawyer" by Law and Politics magazine (2011)--a national publication that honors the top lawyers in the country.
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