SSO Issues New Consensus Guideline On Margins for Breast-Conserving Surgery

02/25/2014 SSO is proud to announce the release of a comprehensive consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer. Developed in conjunction with the American Society of Radiation Oncology (ASTRO), it outlines an evidence-based surgical treatment path that will save patients from unnecessary surgery.

The development of the guideline was led by a multidisciplinary consensus panel headed by co-chairs Monica Morrow, MD, SSO immediate past president and Chief of Breast Surgery at Memorial Sloan Kettering Cancer Center in New York, and Meena S. Moran, MD, Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Conn. The panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.

The results of the study found that positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.

The guideline concludes the use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

SSO received a grant from Susan G. Komen to assist in underwriting the cost of the guideline development process. It is endorsed by the American Society of Clinical Oncology (ASCO) and the American Society of Breast Surgeons (ASBS) and is available via SSO’s website. Supporting rationale and in-depth documentation are available in SSO’s Annals of Surgical Oncology. SSO is providing complimentary access to the journal article in order to increase the impact of this important research.

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