There has been considerable literature on breast conservation therapy over the past few years, with an emphasis on cosmesis and less emphasis on the possible disadvantages of excision with inadequate margins at initial surgery.
Recent literature1 suggests that 1 in 4 women who have had breast conservation therapy require a second operation to remove residual tumours, an improvement over the last few years, but still substantial. Recent literature1,2 suggests that inadequate margins at initial surgery are disadvantageous for patients from a psychological and economic standpoint. There does not appear to be emphasis that having a positive margin at initial surgery negatively influences the likelihood of remaining disease free, although studies3,4 have demonstrated that local recurrence after breast conservation surgery increases systemic disease, which can lead to increased mortality. It has been stated5 that cancer cells have growth factor receptors that are compatible with growth factors in the wound environment and that cancer cells that shed intraoperatively can contribute to both local recurrence and distant metastases.
It is suggested that the cosmetic advantages of removing a specimen 1–2 cm smaller does not warrant the disadvantage of removing a specimen with inadequate margins, particularly since a second procedure negates the cosmetic advantage of removing a smaller specimen. Silverstein and colleagues6 in discussing ductal carcinoma in situ made a comment that should also apply to lumpectomy for neoplasm: “the first excision is the best opportunity to achieve both goals, complete excision and good cosmetic result.”
Footnotes
Competing interests: None declared.