title: Surgical margins and risk of locoregional recurrence in invasive breast cancer: an analysis of 10-year data from the Breast Cancer Treatment Quality Assurance Project.
abstract: OBJECTIVE
  There is debate as to what constitutes an adequate excision margin to reduce the risk of locoregional recurrence (LRR) after breast cancer surgery. We have investigated the relationship between surgical margin distance and LRR in women with invasive breast cancer (IBC).
  
  
  METHODS
  Tumour free margin distances were extracted from histopathology reports for women with IBC, treated by either breast conserving surgery or mastectomy, enrolled in the Breast Cancer Treatment Group Quality Assurance Project from July 1997 to June 2007. Cox proportional hazards regression analyses were conducted to compare the risk of LRR for involved margins compared with negative margins, measured in increments rounded to the nearest mm.
  
  
  RESULTS
  88 of 2300 patients (3.8%) experienced an LRR after a mean follow-up of 7.9 years. An involved margin, or a margin of 1 mm was associated with an increased risk of LRR (HR 2.72, 95% CI 1.30-5.69), whilst margin distances of 2 mm or greater were not. Risk of LRR with margin distances <2 mm was particularly high amongst those not receiving radiotherapy (RT).
  
  
  CONCLUSIONS
  Based on our findings, we recommend that a tumour free margin distance of 2 mm be adopted as an adequate margin of excision for IBC, in the setting of patients receiving standard adjuvant RT and adjuvant drug therapies as dictated by the current clinical treatment paradigms.
authors.affiliation: The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.
authors.forename: Eirene C
authors.initials: EC
authors.lastname: Behm
authors.forename: Kerri R
authors.initials: KR
authors.lastname: Beckmann
authors.forename: Jane E
authors.initials: JE
authors.lastname: Dahlstrom
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhang
authors.forename: Carolyn
authors.initials: C
authors.lastname: Cho
authors.forename: Robin
authors.initials: R
authors.lastname: Stuart-Harris
authors.forename: Paul
authors.initials: P
authors.lastname: Craft
authors.forename: Angela
authors.initials: A
authors.lastname: Rezo
authors.forename: John M
authors.initials: JM
authors.lastname: Buckingham
mesh_terms: D000368:Aged; D001315:Australia; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000592:standards*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D011785:Quality Assurance, Health Care; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
keywords: Breast Cancer Treatment Group; Excision margins; Invasive breast cancer; Pathology; Recurrence; Surgery