New Tool Lowers Risk of Reoperation in Breast Cancer Cases

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When a woman is diagnosed with breast cancer, she often faces a difficult choice.  Should she only have the tumor removed, in a procedure called a lumpectomy, or should she have the entire breast removed, in a procedure called a mastectomy?  The obvious advantage of the lumpectomy is that it saves the breast.  The risk associated with a lumpectomy is that the surgeon may not get all of the cancer.

When a surgeon performs a lumpectomy, he or she cuts out more than just the tumor itself so as to make sure the entire tumor has been removed.  The surgeon then sends the tumor to the pathology department where a pathologist will examine the tumor to see if the margins around the tumor are “clean.”  Clean margins mean that there is no cancer at the edges of the removed tissue and that the entire tumor was successfully removed.  If, however, the margins are not clean, that means that there may still be cancer cells left behind in the breast and a second surgery is necessary to go back and get the rest of it.  The Wall Street Journal recently reported on a new medical device which should improve the chances of getting all of the breast tumor the first time.

The new device is called a MarginProbe.  It is a hand held device which the surgeon can use to explore the margins of the tumor.  If the MarginProbe senses cancer cells, it sets off an alarm and flashes a red light.  If the probe detects only normal cells, it makes a reassuring sound and flashes a blue light.  Early testing indicates that the probe can substantially reduce the need for second surgeries by making it easier for surgeons to get clean margins the first time out.

As with any new technology, there are some problems.  The first is that the device needs to be fully tested to be sure it is as effective and reliable as it appears to be.  The second is that the device can be used only once so that a new MarginProbe must be used for each surgery.  A MarginProbe costs $1,000.00.  At the present time, insurance will not pay for use of the MarginProbe.  There is also a disincentive for hospitals to adopt the MarginProbe.  Under our fee for service model, they don’t get paid for using the probe to reduce second surgeries but do get paid for the second surgery, should one be necessary.  This disincentive almost assures that it will be an uphill battle to get the MarginProbe into wide use.

The manufacturer of the MarginProbe is testing it now to see if it is effective against other forms of cancer where tumors are removed and clean margins are important.

Posted in Breast Cancer, Cancer, Doctors, Fee for Service, Health Care Costs, Health Insurers, Hospitals, Medical Costs, medical ethics |