Though tumor removal is the primary goal of breast cancer surgeons and their patients, most also hope to accomplish this task while conserving as much breast tissue as possible. In some women, administering treatment to shrink a tumor before surgery can reduce the procedure from a mastectomy to a lumpectomy. VCC/Fletcher Allen/UVM surgical oncologists Ted James, MD, and Laurence McCahill, MD, conducted quality outcomes research assessing the utilization of preoperative chemotherapy according to tumor size, as well as breast conservation.

Their study, due to be published in The Breast Journal, found that use of preoperative chemotherapy was associated with reduction of tumor size and an increased rate of breast conservation. However, although still potentially effective, use of this therapy in patients with tumors less than three centimeters in size appeared to be underutilized, even among high volume breast surgeons. Drs. James and McCahill have also compared the use of intra-operative ultrasound vs. mammographic needle localization in patients undergoing partial mastectomy for nonpalpable ductal carcinoma in-situ (DCIS) based on data from the Breast Cancer Surgical Quality Database. They concluded that intra-operative ultrasound, which is less invasive and more cost-effective, should be considered when possible for this patient population.