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Introduction A 2014 consensus statement from the Society of Surgical Oncology and American Society for Radiation Oncology supported “no ink on tumor” as an adequate margin for breast conserving therapy (BCT). This study evaluates this statement in a multi-institution cohort. Methods A retrospective review of BCT cases at 3 comprehensive cancer centers was performed. Women age >18 receiving BCT for T1-2 breast cancer from 2008-2012 were included. Pre-2014, all sites considered 2 mm adequate. Estimated re-excision rates using the 2014 guidelines were calculated and factors predictive of re-excision were analyzed. Results 542 patients (545 lumpectomies) were eligible. Using a ≥2 mm margin standard, 32.8% of patients underwent re-excision compared to 14.1% after 2014 (p < 0.0001). Tumor size (p= 0.003), grade (p=0.015), and lymphovascular invasion (p=0.021) were predictive of re-excision. Patients with additional intraoperative margins excised were less likely to require reoperation (p=0.002). Local recurrence was unaffected by re-excision after mean followup of 66 months. Conclusions The 2014 margin guidelines markedly reduce re-excision rates. There is no difference in local recurrence for patients after re-excision for a close margin versus without Powered.

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7 Background: Ten to 25 percent of patients diagnosed with breast cancer have triple negative breast cancer (TNBC), defined as tumors negative for estrogen, progesterone, and Her2-neu receptors. TNBC is more aggressive than receptor positive cancer. The National Comprehensive Cancer Network (NCCN) recommends BRCA genetic testing for women less than age 60 when diagnosed with TNBC. Methods: The Commission on Cancer registry tumor database was queried for TNBC from 2006 to 2013. Patient demographics were analyzed. Data regarding pathologic details and BRCA testing was collected. Analyses using the Fisher's exact test were conducted. Results: TNBC tumors were identified in the database (n = 173). Sixty-one percent (105/173) of patients were less than 60 years of age, therefore BRCA testing was indicated. Fifteen patients were BRCA positive. Eighty-three percent (87/105) of patients underwent BRCA testing. Seventeen percent (18/105) of patients did not receive BRCA testing that should have under the current guidelines. Patients that did not undergo recommended BRCA testing were more likely to be greater than or equal to 55 years of age (p = 0.002), African-American (p = 0.001), have Medicaid listed as a primary payer (p = 0.021), and have American Joint Commission on Cancer (AJCC) stage 3 disease (p = 0.014). Conclusions: Risk factors for not completing BRCA testing include older age, African-American race, Medicaid insurance status, and stage 3 disease. Health provider awareness of this opportunity for improvement is important to decrease these health disparities. [Table: see text]