An adequate margin of excision in ductal carcinoma in situ

doi:10.1136/bmj.331.7520.789

BMJ 2005;331:789-790 (8 October), doi:10.1136/bmj.331.7520.789

Editorial

An adequate margin of excision in ductal carcinoma in situ

2 mm plus radiotherapy is as good as a bigger margin

The first 150 words of the full text of this article appear below.

The widespread use of mammography screening has led to a changein the perceived pathology of breast cancer. The increased detectionof asymptomatic disease has resulted in an increased incidenceof ductal carcinoma in situ (DCIS), which now accounts for about20% of all cases of breast cancer. In addition, the past decadehas seen a change in the management of primary breast cancer,from mastectomy to breast conservation where possible.¹ Clearlysurgical management of DCIS poses several challenges, none moreso than what should be the width of an adequate margin of resection.What is at issue is the size of the margin that ensures no residualtumour cells while minimising the deformity of the breast.

The National Surgical Adjuvant Breast and Bowel Project (NSABP)regards "no tumour cells on the ink"—that is, a minimalmargin free of disease—as a negative margin. Yet in arecent survey of . . . [Full text of this article]

Malcolm R Kell, fellow in surgical oncology

(malcolmkell@eircom.net)
Department of Surgery, Fox Chase Cancer Centre, Philadelphia, PA 19111, USA

Monica Morrow, chairman, department of surgical oncology

Department of Surgery, Fox Chase Cancer Centre, Philadelphia, PA 19111, USA