title: A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer.
abstract: OBJECTIVE
  Debate continues on what is an adequate margin width to define a clear margin and whether there is a need to excise pectoral fascia or remove skin in breast conserving surgery. This study set out to provide answers to these questions.
  
  
  METHODS
  1411 patients with invasive breast cancer were treated by breast conserving surgery and post-operative whole breast radiotherapy from January 2000 to December 2005. Distance from each margin to any in situ or invasive cancer was measured and recorded. If full thickness of breast tissue was removed no re excision of anterior and posterior margins was performed even if disease was <1 mm from a margin. Patients ≤50 years of age and those with anterior or posterior margins <1 mm to invasive cancer had a radiation boost. Median follow-up time was 6.4 years.
  
  
  RESULTS
  Local in breast tumour relapse (IBTR) occurred in 50 patients. The overall actuarial IBTR rate at 5 years was 2.2%. There was no difference in IBTR when comparing patients with radial margins of 1-5 mm or 5-10 mm. Anterior and posterior margins <1 mm or with ink on tumour cells were not associated with an increase in IBTR.
  
  
  CONCLUSIONS
  There is no justification for radial margins of greater than 1 mm. If the anterior or posterior margin is <1 mm and full thickness of breast tissue has been removed, then re excision of these margins is unnecessary if boost radiotherapy is delivered.
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK. Electronic address: mike.dixon@ed.ac.uk.
authors.forename: J M
authors.initials: JM
authors.lastname: Dixon
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
authors.forename: G R
authors.initials: GR
authors.lastname: Kerr
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Williams
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
authors.forename: C
authors.initials: C
authors.lastname: Dodds
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
authors.forename: I H
authors.initials: IH
authors.lastname: Kunkler
authors.affiliation: Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Macaskill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Breast conserving surgery; Invasive breast cancer; Local recurrence; Margin width