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Invited Commentary
August 26, 2020

Implementing Society of Surgical Oncology and the American Society for Radiation Oncology Margin Guidelines to Reduce Reoperations After Lumpectomy for Early Breast Cancer

Author Affiliations
  • 1Department of Surgery, Subang Jaya Medical Centre, Subang Jaya, Malaysia
  • 2Surgery, University of Malaya, Kuala Lumpur, Malaysia
JAMA Surg. 2020;155(10):e203026. doi:10.1001/jamasurg.2020.3026

Breast-conserving surgery (BCS) and mastectomy for early breast cancer have equivalent survival rates, with a local recurrence rate of 14.3% after 20 years of follow-up in a study.1 Adequate margin status after BCS is an important determinant of local recurrence. The definition of adequate surgical margins is controversial. The National Surgical Adjuvant Breast and Bowel Project B-06 trial was the only trial that defined no ink on margin as an adequate margin. Subsequent studies on margin status after BCS led to the recommendation of 2 mm as the ideal margin width for optimal local control.2 However, local recurrence is also determined by the biological quality of a tumor, in which triple-negative breast cancer (negative estrogen receptor, progesterone receptor, and ERBB2 [formerly HER2]) has been shown to have higher local recurrence rate. Modern radiation techniques with an additional radiation dose to the tumor bed, optimal use of adjuvant chemotherapy, hormone therapy, and targeted therapy also reduce local recurrence.3

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