title: Margins in breast conserving surgery: A practice-changing process.
abstract: Margins in breast conserving surgery (BCS) have been a long standing subject debate. This largely arises from the absence of a consensus on what constitutes an adequate margin width, resulting in re-excision rates of 25-40% for close or positive margins and its consequent impact upon cosmesis, economic costs, patient dissatisfaction and lack of bearing on survival. Accepting that the increased risk of local recurrences (LR) has its influence on survival, the decrease in LR in BCS in the last decade have been motivated by better surgical techniques for assessing negative margins, use of targeted therapies and in general with the multimodal treatment in the management of breast cancer patients. Since the publication of the consensus guidelines on margins there has evolved a trend of changing attitudes towards re-excision. Surgeons are considering margins in the context of all factors including not only patient and tumor characteristics but also the regional and systemic treatment the patient is receiving.
authors.affiliation: Breast Surgical Oncology, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: irubio@vhio.net.
authors.forename: I T
authors.initials: IT
authors.lastname: Rubio
authors.affiliation: Research Oncology, Division of Cancer Studies, King's College London, London SE1 9RT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: T
authors.initials: T
authors.lastname: Kovacs
authors.affiliation: Department of Pathology, Hospital Quiron Barcelona, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Marco
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D017060:Patient Satisfaction; D012086:Reoperation; D012306:Risk; D016019:Survival Analysis
keywords: Breast cancer; Breast conserving surgery; Margins