Trends in the surgical treatment of breast cancer

Here, we review the relationship between local recurrence (LR) and disease burden, biology, and targeted therapy. There is still little consensus on what constitutes an adequate margin for breast-conserving surgery, and it is not clear that margins more widely clear than tumor not touching ink decrease LR further. It is important to recognize that clear margins do not indicate the absence of microscopic tumor in the breast and that differences in margin width of a few millimeters do not alter the rates of LR. The molecular subtype of cancer is a powerful predictor of both distant and local relapse risk. Effective systemic therapy, targeted therapy in particular, significantly decreases LR. It is extremely unlikely that there is one margin width that is appropriate for all patients with breast cancer. Further progress in the individualization of local therapy requires a move beyond the fixation on disease burden and the recognition that extent of local therapy should be tailored to tumor biology.