[Skip to Navigation]
Invited Commentary
December 2014

Breast Conservation Surgery and the Definition of Adequate Margins: More Is Not Better…It’s Just More

Author Affiliations
  • 1Department of Surgery, Washington University School of Medicine, St Louis, Missouri
  • 2Sisters of St Mary’s Breast Care, St Charles, Missouri
JAMA Surg. 2014;149(12):1305. doi:10.1001/jamasurg.2014.950

The definition of a sufficient margin after attempted breast conservation surgery for breast cancer has been a hotly debated topic for decades. Although there has been widespread acceptance that breast conservation surgery confers an equivalent survival outcome to mastectomy in prospective randomized trials,1,2 there is a paradoxical reluctance to agree on what constitutes a negative margin and successful surgical excision. The study by Wilke et al3 illustrates this finding; 23.6% of all patients in a large national database undergoing breast conservation surgery subsequently underwent lumpectomy or mastectomy. Furthermore, the percentage of reexcisions decreased only slightly from January 1, 2004, through December 31, 2010. The authors were unable to obtain exact pathologic margin width, but more than 92% of the patients had negative margins, indicating that a significant percentage of those undergoing additional operations had margins that were “negative at ink.”