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Susan Scanlan

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Positive Margins, Positively Unacceptable: How We Can Help Women Get on the Road to Recovery After Breast Cancer Surgery

Posted: 02/15/2013 5:36 pm

My family sometimes jokes that we are a sorority that is bound together by our bosoms. My grandmother and mother both died of metastatic breast cancer, my sister was diagnosed when she was 43 years old, and I got the news about six years ago.

Like many women today, I was lucky to be diagnosed early, thanks to increased breast cancer awareness and advancements in detection. More than half of all current breast cancer diagnoses are for early-stage cancers in which the tumor cannot be felt during a breast exam.

In consultation with my doctor, I decided the best treatment for my cancer was lumpectomy with radiation. During a lumpectomy, surgeons aim to remove the cancer with a rim of healthy tissue around it, while conserving the breast. Most patients also receive five to seven weeks of radiation therapy shortly after the surgery in order to eliminate any cancer cells that may remain in the breast tissue.

When my surgery was over, the doctor sent the tissue he had removed from my breast to a pathology lab to be analyzed for positive margins. This analysis typically takes one week or more.

I had every confidence in the world that this was the right treatment for my cancer and that I'd soon be on the road to recovery. But when the pathology report came back, the doctor informed me that they had not achieved clean margins. This was devastating news. I had to make a decision: another lumpectomy, a mastectomy or leave the cancer in my breast.

According to a study published in the Journal of the American Medical Association, 30 to 60 percent of early-stage breast cancer patients who undergo an initial lumpectomy procedure will require a repeat surgery due to positive margins. The same study found when patients learn of this, it is not uncommon for between 10 and 36 percent of them to elect a full mastectomy to ensure all the cancer is removed.

I weighed my own family history and chose to undergo a double mastectomy. As breasts are associated with femininity and identity, losing one or both breasts can sometimes lead to physical and emotional trauma. Yet studies have shown double mastectomies are on the rise, up from less than 3 percent of all cases in the late 1990s to 15 percent today.

The fear of not removing all the cancer has led many women to question the effectiveness of lumpectomy surgery. However, recent studies in the New England Journal of Medicine have shown lumpectomy is as effective as, if not more effective than, mastectomy and may result in better survival. This study suggests that as long as the patient has clean margins, lumpectomy can be the best option for women. So there's one roadblock standing in the pathway to recovery: positive margins.

But there is hope. Many doctors, hospitals and researchers are looking for ways to reduce the incidence of positive margins.

For example, Brigham and Women's Hospital in Boston has built a specialized operating suite that includes a unique MRI machine attached to the ceiling. During the procedure, the MRI takes images of the tissue where the breast cancer was removed. The images are then assessed for additional cancer remaining in the breast, allowing the surgeon to remove additional tissue if necessary, before the patient comes out of surgery,

Another innovation in the field is the recently FDA-approved MarginProbe System. The MarginProbe System is an intra-operative assessment device that significantly improves breast surgeons' ability to identify cancer on the margin, reducing the risk of positive margins. Data shows that it is more than three times more effective in finding positive margins than traditional methods alone, such as feeling and looking at the tissue.

With innovations like the MarginProbe System and the investments like those made at Brigham and Women's Hospital, we are one step closer to avoiding situations like the one I was forced to face.

As a surviving sister in the breast cancer sorority, I look forward to the day when positive margins no longer stand in the way of a woman's safe and speedy path to recovery and remission.

For more on breast cancer, click here.

 
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