In an interview with the journal published online, McCahill was asked what factors might contribute to the wide variation. "The main things are probably technical factors, involving either the surgeon's technique or how the surgeon coordinates with the pathologist at the hospital. Have is the process and half is probably opinion." He added, "We need to get down to a more acceptable range of reexcision, down to 5% to 20% in the next 5 to 20 years."
Monica Morrow, MD, of the Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York and Steven Katz, MD, at the Department of Medicine and Health Management and Policy at the University of Michigan, wrote an opposing editorial in the same issue saying that reexcision should not be used as a quality measure.
Legitimate clinical variables may drive the surgeon's decision to perform reexcision, including the method of pathological margin processing, quality of preoperative imaging, histological tumor type, and the patient's age, they said.
They agree that quality measures seem to have bypassed the field of breast cancer surgery. But they argued that if re-excision is used as a quality measure, surgeons may take more tissue unnecessarily just to play it safe.
But they say that surgeons and radiation oncologists share no consensus "as to what constitutes an optimal negative margin width because the question has not been addressed in prospective randomized trials."
"Perhaps the most important limitation of using reexcision as a quality measure is the potential consequences of its adoption," they wrote. It "raises the possibility that this information might be used to direct patients to different surgeons based on having the 'right rate.' "