Importance of margin width in breast‐conserving treatment of early breast cancer

Bodilsen, Anne; Bjerre, Karsten; Offersen, Birgitte Vrou; Vahl, Pernille; Amby, Nikolaj; Dixon, JM; Ejlertsen, Bent; Overgaard, Jens; Christiansen, Peer

doi:10.1002/jso.24224

Cited by 32 publications

(23 citation statements)

References 41 publications

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“…37,39,40 Early results from a large Danish study of 11 900 patients found no evidence of improved local control by margin depth. 41 A previous study found that patients treated without a boost (usually because of a large excision specimen or a negative re-excision) had no increase in the risk of local recurrence compared with patients who did receive a boost. 31 In practice, the surgeon can assist boost planning by placing titanium clips at the excision borders.…”

Section: Discussionmentioning

confidence: 98%

Radiation therapy and early breast cancer: current controversies

Boyages

2017

Medical Journal of Australia

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Radiation therapy (RT) is an important component of breast cancer treatment. RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy. Short courses of RT over 3-4 weeks are generally as effective as longer courses. A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified. A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins. Axillary recurrences can take a long time to appear, with 35% occurring after 5 years. Leaving disease untreated in regional nodes is associated with reduced survival. Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy. Modern RT equipment and techniques will further improve survival rates.

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Section: Discussionmentioning

confidence: 98%

Radiation therapy and early breast cancer: current controversies

Boyages

2017

Medical Journal of Australia

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“…Then an alternative surgical management for early breast cancer has emerged, named as breast conserving surgery (BCS), where instead of removing the entire breast, only the tumour with a cuff of normal tissue all around is removed. [9][10][11][12] The contour and cosmetic appearance of the breast is preserved. Axillary nodes are addressed through a separate axillary incision.…”

Section: Introductionmentioning

confidence: 99%

Proportions and reasons for breast conservation surgery and modified radical mastectomy in early breast carcinoma

2019

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Background: Breast cancer is a common cancer among women in India and its incidence is increasing in an alarming rate. There is a paradigm shift in the management of early breast cancer with more emphasis given to breast conservation treatments. This study aimed to assess the proportion of patient underwent breast conservation surgery and reasons to choose breast conservation surgery or modified radical mastectomy in early breast cancer. Methods: Information of 41 patients with early breast carcinoma who attended the institute during the study period and who can choose either modified radical mastectomy or breast conservation surgery depending on their wish are included in the study group and the data thus obtained was entered in MS Excel data sheet and analysed using SPSS 16 software. Results: It was observed that the proportion of women selecting breast conserving therapy increased with improved literacy status. Similarly, menstrual status and location of tumor do have an influence in choosing breast conserving surgery with significant statistical correlation. However, unlike the previous studies we did not find any statistically significant association between age and surgical decision. Similarly, place of residence, and employment status of the patient does not influence the decision to undergo breast conservation surgery. Conclusions:We have to create awareness in the society about the safety of breast conservation treatment to popularize this modality of treatment there by more and more organs can be preserved.

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“…1 Despite this equivalence in outcome, positive surgical margins following BCT have been associated with a significantly increased risk of local recurrence. 2–6 Margin status has become a critical factor in the management of patients undergoing BCT, and the controversy surrounding the importance of negative margins and the absence of definitive guidelines have led to a wide variability in surgeon practice regarding the threshold for re-excision. In 2002, the landmark National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial prompted the widespread acceptance of BCT and considered no tumor cells at the inked specimen margin to be a negative margin, but this definition failed to translate universally into practice until recently.…”

Section: Introductionmentioning

confidence: 99%

“…Prior to early 2014, up to 60% of patients underwent re-excision for management of margins, and adequacy of pathologic margin status remained surgeon-specific and highly ambiguous, ranging from no tumor at the inked margin to margin widths > 5 mm. 6–11 In May 2014, the Society of Surgical Oncology (SSO) and American Society of Radiation Oncology (ASTRO) published a consensus statement recommending that the definition set forth in NSABP B-06 become the global standard for an adequate margin in breast-conserving surgery (BCS) in women with stage I/II disease undergoing adjuvant whole breast radiation therapy. 12 Drawing upon a meta-analysis of 33 studies, a multidisciplinary consensus panel determined that no significant differences in local recurrence were present regardless of factors such as patient age, tumor biology, or presence of an extensive intraductal component in the setting of “no ink on tumor”.…”

Section: Introductionmentioning

confidence: 99%

Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery

Elmore

Cyr

et al. 2017

Journal of the American College of Surgeons

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Background The SSO/ASTRO consensus statement was the first professional guideline in breast oncology to declare “no ink on tumor” as a negative margin in patients with stages I/II breast cancer undergoing breast conservation therapy (BCT). We sought to analyze the financial impact of this guideline at our institution using a historic cohort. Study Design We identified women undergoing re-excision following breast-conserving surgery for invasive breast cancer from 2010–2013 using a prospectively-maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. Results Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with DCIS. A subcohort of 83 patients (32.7%) who underwent BCT for Stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure per the SSO/ASTRO guideline. The majority had invasive ductal carcinoma (70, 84.3%) and had invasive disease (45, 54.2%) and/or DCIS (49, 59.0%) within 1 mm of the specimen margin. Seventy-nine patients underwent one re-excision, and 4 patients underwent two re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. Conclusions Implementation of the SSO/ASTRO consensus guideline holds great potential to optimize resource utilization. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200,000. Further analysis of patient outcomes and margin assessment methods is needed to define the long-term impact on surgical practice.

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Importance of margin width in breast‐conserving treatment of early breast cancer

Cited by 32 publications

References 41 publications

Radiation therapy and early breast cancer: current controversies

Radiation therapy and early breast cancer: current controversies

Proportions and reasons for breast conservation surgery and modified radical mastectomy in early breast carcinoma

Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery

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