Breast Cancer: Guidelines on Margins for Breast-Conserving Surgery

dr_monica_morrow Interview Invitation with:

Monica Morrow MD
Anne Burnett Windfohr Chair of Clinical Oncology
Chief Breast Service memorial Sloan Kettering Cancer Center What are the main findings of the study?

Dr. Morrow: The study is the report of a Consensus panel examining the question of whether more widely clear lumpectomy margins than no ink on tumor decrease local recurrence.  A metaanalysis of published literature was used as the primary evidence base for the conclusion. Where any of the findings surprising?

Dr. Morrow: There has been a pervasive feeling that bigger margins are better margins.  In the current era, when the majority of patients receive some form of systemic therapy, which not only prolongs survival, but reduces local recurrence, evidence does not show this to be true. While this may surprise some, it is worth noting that the NSABP has always used the definition of no ink on tumor as a negative margin in their clinical trials with excellent local control outcomes. What should providers and patients take away from this report?

Dr. Morrow: The consensus does not indicate that re-excision should never be done to obtain more widely clear margins.  What it does say is that rules such as all margins must be >2mm which are in place in many institutions are not supported by evidence and lead to unnecessary surgery. What further research do you recommend as a result of this work?

Dr. Morrow: This guideline is specific to patients with invasive cancer treated with whole breast irradiation.  It would be useful to have similar data for patients with ductal carcinoma in situ and those receiving pre-operative  chemotherapy.


Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer
Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-Macgregor M, Freedman G, Houssami N, Johnson PL, Morrow M.

J Clin Oncol. 2014 Feb 10. [Epub ahead of print]

Last Updated on September 14, 2014 by Marie Benz MD FAAD