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Why the surgeon you choose matters in treating noninvasive breast cancer

University researcher Beth Virnig, Ph.D., M.P.H., answers questions about a new study showing that surgical outcomes vary widely

For women with noninvasive breast cancer, some treatments are better than others, and patients do better if their “margins” are negative—meaning surrounding tissue containing cancer cells is removed along with the tumor. This was confirmed by a widely publicized study published early in January by the Journal of the National Cancer Institute. But the researchers also discovered that choice of surgeon affects outcomes as well. In an editorial accompanying the study, Masonic Cancer Center researcher Beth Virnig, Ph.D., M.P.H., says the findings highlight the importance—and the difficulty—of choosing a cancer physician.

Why does the surgeon matter in treating noninvasive breast cancer?

In the recent study, the physician accounted for up to 35 percent of the variation in outcomes, including recurrence or progression to invasive cancer. What was surprising was how big an effect this was, particularly after taking into account all other risk factors, such as how big and how aggressive the tumor was. The study doesn’t identify what accounts for this variation among surgeons.

Why are tumor margins so important?

In this study, women who had positive margins—less than 2 millimeters of cancer-free breast tissue removed along with the tumor—were more likely to have a recurrence than others, and some surgeons were more likely than their peers to leave positive margins. Even among professionals, however, the idea of positive margins isn’t clear-cut. There’s debate about how many millimeters of clean tissue is needed. Depending on where the tumor is located and its shape, you may get all the cancer but still not achieve a negative margin.

Read more about Beth Virnig and her role as coleader of the Masonic Cancer Center’s Outcomes and Survivorship program.

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