Margins in Breast-Conserving Surgery for Early Breast Cancer: How Much is Good Enough?
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Breast-conserving therapy (breast-conserving surgery (BCS) and radiation therapy) is an effective treatment for early-stage breast cancer (BC). Whilst there is consensus that risk of local recurrence (LR) following BCS is increased if the surgical margins are positive (‘ink on tumour’), consensus on what constitutes adequate negative margins has been elusive despite studies spanning decades. Recent SSO–ASTRO guidelines have recommended ‘no ink on tumour’ as the standard for negative margins in BCS for invasive BC. These were underpinned by study-level meta-analysis reporting that a minimally defined negative margin width be adopted for BCS in invasive BC and showing that wider (than a minimum >1 mm) negative margins do not significantly reduce LR risk. Recommendations on a minimum margin width for ductal carcinoma in situ (DCIS) vary substantially from >1 to 10 mm or wider; evidence-based guidelines are being developed and are expected to address ‘how much is enough’ for margin width in DCIS.
KeywordsBreast cancer Ductal carcinoma in situ Breast-conserving therapy Local recurrence Margins Meta-analysis Local–regional evaluation Early breast cancer Review
Compliance with Ethical Standards
Conflict of Interest
Nehmat Houssami receives research support through the National Breast Cancer Foundation (NBCF Australia) Breast Cancer Research Leadership Fellowship.
M. Luke Marinovich receives research support through a Cancer Institute NSW Early Career Fellowship.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as • Of importance
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