Agreement: I AgreeBody: Dear Editor,
Tumor free margin: wider is better
This review article has gathered all the evidence about the impact of margin status on local and distant metastasis and survival among patients who had undergone breast cancer conservation surgery (BCS). Yet, there is no international consensus regarding the width of margin to be excised around the early-stage breast cancers that are subjected to BCS. The authors have quoted studies from UK, USA, and other European nations having different recommendations for margins. At the same time, the article itself has given varied statement showing difference of 1 mm between the heading ‘Conclusion: ‘A margin of no tumour on ink is inadequate and we recommend a minimum tumour free distance of 1 mm from the margin…’ and the heading ‘What this study adds: ‘….close margins (no tumour on ink, but tumour <2 mm) were associated with increased distant recurrence compared with wider margins’.(1)
The evidence available so far mandates the International Association or Society of Oncology to standardize the method of measurement of width from the tumor margin on the table, considering the fact that this is a live tissue which is going to ‘shrink’ by the time it reaches the pathologist, and the measurement would definitely vary. In addition, on table frozen section biopsy from the margin is a helpful tool to ensure adequate tumor free margin rather than subjecting the patient for re-excision, which causes pain, distress, complications, increased cost and take away avoidable extra O.T time. It is bit difficult to comprehend if a margin of 2mm or a bit more would dramatically affect cosmesis, which will psychologically prove more disastrous than leaving a tumor positive or with a close margin.
Though the paper is silent about grade of tumor, which is an independent risk factor for recurrence, it could be included in future study. Same thing goes for margin on the under-surface of the tumor, how far it is from the chest muscles, if it is too close like the margin on the periphery, it will have the same impact.
References:
Bundred James R, Michael S, Stuart B Beth. Margin status and survival outcomes after breast cancer conservation surgery: Prospectively registered systematic review and meta-analysis. BMJ 2022;378:e070346
No competing Interests: YesThe following competing Interests: Electronic Publication Date: Friday, September 30, 2022 – 16:50Highwire Comment Subject: Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysisWorkflow State: ReleasedFull Title: Re: Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis
Highwire Comment Response to: Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysisCheck this box if you would like your letter to appear anonymously:: Last Name: MurmuFirst name and middle initial: Prof. LakhiramEmail: lrmurmu@hotmail.comAddress: Al-Falah School of Medicine and Research Centre, Al-Falah University, Dhauj, Faridabad, Haryana, IndiaOccupation: Medical SuperintendentOther Authors: Dr. Sushimta Murmu, Assistant Professor PsychaitryAffiliation: Al-Falah School of Medicine and Research Centre, Al-Falah University, Dhauj, Faridabad, Haryana, IndiaBMJ: Additional Article Info: Rapid response