Removing more tissue during a partial mastectomy could spare thousands of breast cancer patients a second surgery, according to a Yale Cancer Center study. The findings were published online on May 30, 2015 in an open-access article in the New England Journal of Medicine and presented at the 2015 Annual Meeting of the American Society of Clinical Oncology in Chicago, which runs from May 29 through June 2. The NEJM article is titled “A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer.” Nearly 300,000 women in the United States are diagnosed with breast cancer each year; more than half undergo breast-conserving surgery with a partial mastectomy to remove the disease. However, between 20% and 40% of patients who undergo this procedure have "positive margins," or cancer cells found at the edge of what is removed. The presence of positive margins often leads to a second surgery to ensure that no cancer remains. The Yale study explored how removing more tissue all the way around the tumor site during the initial surgery -- known as cavity shave margins (CSM) -- could reduce the need for a second surgery. In this study of 235 patients with breast cancer ranging from stage 0 to stage III, surgeons performed a partial mastectomy as they normally would. Patients were then randomized in the operating room to either have additional CSM removed or not. "Despite their best efforts, surgeons could not predict where the cancer was close to the edge," said the study's lead author, Dr. Anees Chagpar, Associate Professor of Surgery (Oncology) at Yale School of Medicine and director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven.
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