New Study Reports Improved Patient Outcomes For Breast Cancer Patients

Main Category: Breast Cancer
Article Date: 19 Feb 2009 - 2:00 PDT

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A new clinical study published this month in The Breast Journal (Vol. 15, No. 1) reports that high-quality patient outcomes for breast-conserving surgery can be achieved in the community hospital setting. This is one of the few and the most recent studies of its kind and is particularly relevant given that nearly two-thirds of all breast cancer patients in the United States are treated at community centers.

The study tracked 185 cases from 1997-2003 at Henry Mayo Newhall Memorial Hospital, located in the Southern California suburb of Valencia. The patients underwent a lumpectomy typically with a 5mm margin, as opposed to the 1-2mm margin performed in surgeries at most institutions. The study includes five-year follow-up data that shows a local recurrence rate of 2 percent as compared to the national norm of 4-9 percent.

"This study basically suggests a resetting of the bar on how to do lumpectomies and what patients can expect if it is done this way," said Henry Mayo's Breast Center Medical Director Gregory Senofsky, M.D. "Our findings are hard to ignore."

According to Barbara Florentine, M.D., medical director of the department of pathology at Henry Mayo and lead author of the study, the first objective of the study was to evaluate the factors known to influence outcomes. "These include tumor and patient characteristics, completeness of local surgical tumor excision, and adjuvant radiation therapy and/or chemotherapy/hormonal treatment," she says. "The second objective was to evaluate the percentage of cases in which the initial breast-conserving surgery did not achieve adequate surgical oncological results (5mm margins) and the number and type of subsequent surgeries that were required to achieve this goal."

Of the 185 cases tracked in this study, 87 percent had successful breast-conserving surgery. A single surgery was deemed sufficient to achieve the desired outcome in 54 percent of the cases while 46 percent required additional surgeries because of the 5mm requirement. Survival rates for patients undergoing this treatment at Henry Mayo compared favorably with data presented by the National Council Database reporting on outcomes at teaching/research hospitals. Disease free survival for early stage cancer was 91 percent at five years.

The flap-advancement reconstruction surgery performed by Dr. Senofsky requires a team that includes a specially trained surgeon and radiologist plus the presence of a pathologist in the operating room to provide real-time information. "The procedure requires extra work and extra training in how radiologists insert the wires and how surgeons approach their craft relative to performing larger targeted lumpectomies with excellent cosmetic results, but it is what patients should come to expect based on our study," he said.

"It is difficult to successfully obtain adequate excision of the cancer while still maintaining a beautiful breast with no distortions--and that's very important to a woman," stated Dr. Florentine. "Dr. Senofsky is able to achieve both through the use of oncoplastic techniques."

While Henry Mayo has no comprehensive breast center building, the hospital does provide equivalent services thanks to a well-integrated medical campus and a multi-modality breast team that meets regularly to discuss care plans tailored to the uniqueness of each patient, including age, health status, risk factors, and the patient's own desires and needs. The hospital owns and operates the pathology, breast imaging, and inpatient and outpatient surgical operating suites while on-campus radiation, medical oncology and breast surgery services are provided by independent physician groups.

The study was conducted by a nine-person investigative team, six of whom are affiliated with Henry Mayo. Leading the study were Drs. Senofsky and Barbara Florentine. In addition to his role at Henry Mayo, Dr. Senofsky is a clinical faculty member at UCLA's surgical oncology department and the author of The Patient's Guide to Outstanding Breast Cancer Care. Dr. Florentine is medical director of the department of pathology and is affiliated with the department of pathology at the Keck School of Medicine at the University of Southern California. Additional Henry Mayo participants include physicians John Barstis, M.D.; Alexander Black, M.D.; and Robert Zimmerman, M.D., along with Brian Cooper, tumor registrar officer.

ABOUT HENRY MAYO - Henry Mayo Newhall Memorial Hospital is a 221-bed not-for-profit acute-care hospital serving the Santa Clarita Valley since 1975. Services include trauma, emergency, intensive care, maternity, surgery, nursing, wound care, behavioral health, and acute rehab as well as cancer, cardiology, imaging, lab, digestive, respiratory services, and physical and occupational therapies

Henry Mayo Newhall Memorial Hospital
http://www.henrymayo.com