Background Re-excision is common in BCS, in part due to lack of consensus on margin definitions. A population-based sample of surgeons was used to determine current attitudes toward margin width and identify characteristics associated with margin choice. Methods Breast cancer patients treated from 2005–2007 were identified from the L.A. and Detroit SEER registries. Pathology reports were used to identify their surgeons, who were surveyed (n = 418). Response rate was 74.6% (n = 312). Mean surgeon age was 51.9 years, 17.8% were female, and the mean number of years in practice was 18.5. Results Wide variation in margin selection was noted among surgeons, and did not differ for invasive cancer and DCIS plus radiotherapy. In a T1 invasive cancer scenario, 11% of surgeons endorsed margins of tumor not touching ink (TNTI), 42% of 1–2mm, 28% of ≥5mm, and 19% >1cm as precluding re-excision. On multivariate analysis, having 50% or more of practice devoted to breast cancer independently predicted smaller margin choice (p=0.03). For a patient with a 1.4cm grade 2 ER positive DCIS without RT planned, 3% of surgeons chose TNTI, 12% 1– 2mm, 25% ≥5mm, and 61% >1cm as precluding re-excision. Breast specialization independently predicted larger margin choice (p=0.03). Gender and years in practice were not predictive of margin choice. Conclusion Wide variation in BCS margin definition exists. Variation is similar for invasive cancer and DCIS with RT, with more specialized surgeons choosing smaller margins. In DCIS without RT, more specialized surgeons favored larger margins. A standardized margin definition may significantly affect re-excision rates.

The risk of clinically significant thromboembolic event in trauma patients under age 13 is negligible. Therefore, VTE prophylaxis is unnecessary in pediatric patients with traumatic injury.

Purpose To examine the role of pre-operative magnetic resonance imaging (pMRI) on time to surgery and rates of re-operation and contralateral prophylactic mastectomy (CPM) using a population-based study of New Jersey breast cancer (BC) patients. Methods The study included 289 African-American and 320 white women who participated in the Breast Cancer Treatment Disparity Study and underwent breast surgery for newly diagnosed early stage BC between 2005 and 2010. Patients were identified through rapid case ascertainment by the New Jersey State Cancer Registry. Association between pMRI and time to surgery was examined using linear regression, and with re-operation and CPM using binomial regression. Results Half (49.9%) of the study population received pMRI, with higher use for whites compared to African-Americans (62.5% versus 37.5%). After adjusting for potential confounders, patients with pMRI than those without, experienced significantly longer time to initial surgery (geometric mean= 38.7 days; 95% confidence interval: 34.8, 43.0 versus 26.5 days; 95% confidence interval: 24.3, 29.0), significantly higher rate of CPM (relative risk [RR]= 1.82; 95% confidence interval: 1.06, 3.12), and non-significant lower rate of re-operation (RR= 0.76; 95% confidence interval [CI]: 0.54, 1.08). Conclusions pMRI was associated with significantly increased time to surgery and higher rate of CPM, but it did not affect the rate of re-operation. Physicians and patients should consider these findings when making surgical decisions based on pMRI findings.