Lumpectomy is an option sometimes available to those who don't want to undergo a mastectomy but a national review shows that a quarter of those who choose breast conservation are repeating surgery to cut risks of their cancer returning.

Using data from the National Cancer Database, Dr. Lee Wilke from University of Wisconsin's Health Breast Center, Dr. Katharine Yao from NorthShore University Health System and colleagues analyzed surveys from 316,114 patients to determine how many of those electing for lumpectomies is being asked to return for another surgery. The results of the review are published in JAMA Surgery, an American Medical Association journal.

What's more concerning about the sheer number of women going back to surgery after a lumpectomy is that the reasons why they have to are not necessarily medical. Often, the number of repeat surgeries is affected by demographics and the fact that doctors differ in opinion regarding what is considered adequate for surgical margins involving cancer-free tissues.

According to the journal's editorial for the review, over 200,000 new invasive breast cancers are diagnosed every year. This is a big number and it represents women who are going under the knife unnecessarily. It is time to adhere to one standard for determining cancer margins, setting aside biases for the benefit of women with breast cancer.

"Past studies were too small and too regional to know the true national statistics. Now we have a baseline, and while it declined slightly during the study period (from 25.4 to 23.7 percent) it is still too high. We'll never get to zero but 10 percent is a reasonable goal," explained Wilke.

The review went over lumpectomy cases in the United States between 2004 and 2010. It found out that younger women are likelier to undergo repeat surgery, as well as those who had larger tumors, had their initial surgery at teaching hospitals, or lived Northeast.

National cancer organizations are well aware of the problem, citing data from a study that used the "no tumor on ink" rule as a clear margin definition for early state invasive cancer. The "no tumor on ink" rule involves coating a tumor with ink after it is removed by a surgeon. A pathologist then examines the sample. If cancer cells are not found in the ink-coated edge of the sample, a second surgery is unlikely to be needed.

The JAMA editorial also supports the adoption of the "no tumor on ink" rule.

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