Guideline glory.

June 8, 2017. A large retrospective cohort series of 3729 patients undergoing initial lumpectomy for breast cancer was published this week in JAMA showing re-excision and subsequent mastectomy rates significantly declined by 16% (p<0.001) from 2013 to 2015. This is being attributed to 2013-2014 publications on national consensus guidelines re: what really constitutes negative margins (read: no tumor on ink). But it's not all good news. Still 41% of re-excisions in this cohort were performed after a margin-negative resection. As a corollary, a survey of 342 surgeons demonstrated a significant relationship between volume (>50 breast cancer cases per year) and adherence to guidelines. So while guidelines can't fix everything, they can fix a lot. And this is good news for lumpectomy-patients' anxiety, cosmesis and pocketbooks.

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