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SSO-ASTRO 2014 Consensus Guideline on Margins for Breast-Conserving Surgery Correlate to a Significant Decrease in Surgery After Initial Lumpectomy – June 2018

Author: SSO Staff
Jun 14, 2017

A June 5, 2017 online publication in JAMA Oncology by Monica Morrow, MD, et al, “Trends in Reoperation After Initial Lumpectomy for Breast Cancer,” evaluates the impact of a 2014 consensus guideline on margins for breast conserving surgery by Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO). The study showed a significant decline in surgery after initial lumpectomy by 16% (P<0.001) and more than two-thirds of surgeons endorsing a margin of “no ink on tumor.” 1

The study was a population-based cohort survey study of 7,303 eligible women with stage I and II breast cancer diagnosed in 2013 to 2015 and reported to the Georgia and Los Angeles County, CA Surveillance, Epidemiology and End Results registries. After exclusion criteria were applied, the analytic sample was comprised of 3,729 patients.  The study also compared rates of reexcision and subsequent mastectomy after initial lumpectomy in April 2013 and April 2015.  The rates were 21% and 13% and 14% and 4% respectively. The difference over the two-year period was significant (P<0.001). The decrease in surgery after initial lumpectomy led to a significant increase in the rate of final lumpectomy and a decrease in both unilateral and bilateral mastectomy.

The findings come approximately three years after the release of the SSO-ASTRO consensus guideline statement, which was endorsed by American Society of Clinical Oncology and the American Society of Breast Surgeons. The guideline was based upon a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from 33 studies that included 28,162 patients. The multidisciplinary expert panel concluded that negative margins (no ink on tumor) minimized the risk of IBTR and wider margin widths do not significantly lower this risk.  Furthermore, the routine practice to obtain wider negative margin widths than no ink on tumor is not indicated.2

Morrow’s study also evaluated the adoption of the guidelines by surveying the attitudes of attending surgeons who conducted the cohort patients’ surgeries.  Findings indicated that 69% of surgeons now endorse a margin of no ink on tumor as adequate to avoid reexcision for both estrogen receptor-positive progesterone receptor-positive and estrogen receptor-negative progesterone receptor-negative patients. The SSO-ASTRO consensus guidelines on Margins for Breast-Conserving Surgery correlates to the change in the surgeons’ attitude about margins.  Armando E. Giuliano, MD, SSO President Elect; Cedars-Sinai Cancer Institute, Co-Director of the Saul and Joyce Brandman Breast Center says, “Having served on the multidisciplinary panel that developed the consensus guidelines, it is remarkable that such strong evidence already exists that demonstrates the acceptance of no ink on tumor by surgeons.”

“As the preeminent surgical oncology organization, SSO partners with organizations across the cancer care spectrum to develop and implement guidelines that enhance clinical outcomes in efficient, yet scientifically supported ways,” said Kelly McMasters, MD, PhD, SSO President; Ben A. Reid, Sr., MD, Professor and Chairman, The Hiram C. Polk Jr., MD, Department of Surgery, University of Louisville. “We continue to work with leaders in the field to evaluate where our guidance could have the biggest impact.”

About the Society of Surgical Oncology
The Society of Surgical Oncology (SSO) is the premier organization for surgeons and health care providers dedicated to advancing and promoting the science and treatment of cancer. The Society’s focus on all solid-tumor disease sites is reflected in its Annual Cancer Symposium, monthly scientific journal (Annals of Surgical Oncology), educational initiatives and committee structure. The Society’s mission is to improve multidisciplinary patient care by advancing the science, education and practice of cancer surgery worldwide.

  1. Morrow M., et. al.Trends in Reoperation After Initial Lumpectomy for Breast Cancer.JAMA Oncol. Published online June 5, 2017.
  2. Moran M., et. al.Society of Surgical Oncology-American Society for Radiation Oncology consensus Guideline on Margins for Breast-Conversing Surgery with Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer.Ann Surg Oncol. 2014;21:704-716.
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