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Recommendation
Surgical margins – Indications for further surgery #2
Consider further surgery (re-excision or mastectomy, as appropriate) after breast-conserving surgery where there is invasive cancer and/or DCIS within 2mm of but not at the radial margins (>0mm and <2 mm).
For women who have had breast-conserving surgery where invasive cancer and/or DCIS is present within 2 mm of, but not at, the radial margins (greater than 0 mm and less than 2 mm): discuss the benefits and risks of further surgery (re-excision or mastectomy) to minimise the risk of local recurrence; take into account the woman's preferences, comorbidities, tumour characteristics and the potential use of radiotherapy (also see radiotherapy after breast-conserving surgery)
How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 used wording ('Discuss') indicative of the need for shared decision-making by the source guideline authors. The source recommendation was adapted by making it more directive by replacing 'discuss' with 'consider' and simplifying it by removing the specific points for discussion. The NICE committee indicated that there was not enough evidence to clearly define an optimum margin width between 0 mm and 2 mm to minimise local recurrence rates and minimise further surgery, and the committee agreed this was an important topic for further research.
Surgical margins – Indications for further surgery #2
Recommendation
Consider further surgery (re-excision or mastectomy, as appropriate) after breast-conserving surgery where there is invasive cancer and/or DCIS within 2mm of but not at the radial margins (>0mm and <2 mm).
Principles in action
Communication
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 used wording ('Discuss') indicative of the need for shared decision-making by the source guideline authors. The source recommendation was adapted by making it more directive by replacing 'discuss' with 'consider' and simplifying it by removing the specific points for discussion. The NICE committee indicated that there was not enough evidence to clearly define an optimum margin width between 0 mm and 2 mm to minimise local recurrence rates and minimise further surgery, and the committee agreed this was an important topic for further research.