BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 elected to undergo a further re-excision breast procedure, including seven undergoing a re-excision BCS procedure, eight undergoing a completion mastectomy, and one undergoing a re-excision BCS procedure (with further pos- itive margins) followed by a completion mastectomy. Of the 204 BCS cases, 174 patients have maintained serial follow-up (with a mean follow-up duration of 38.6 months and a range of follow-up duration from 19.1 to 63.4 months), 22 patients have been noncompliant and have not maintained any identifiable follow-up, and eight patients are currently known to be deceased. Only three documented recurrences of disease related to their breast cancer are known within this series. This includes: (1) a case of recurrence within multiple distant sites in an indi- vidual undergoing a BCS procedure with an intact tumor (with positive BCS margins) who declined initial evalua- tion of the axillary lymph nodes, declined a subsequent recommended re-excision BCS procedure or completion mastectomy, and declined other recommended adjuvant therapies (with recurrence 4 months after the original BCS procedure); (2) a case of concurrent recurrence within the completion mastectomy site and multiple distant sites in an individual undergoing a re-excision BCS procedure (with positive BCS margins) and evaluation of the axillary Table 1: Patient demographics of all 204 BCS cases Patient demographics Age (years) Height (inches) Weight (pounds) Body mass index Race Caucasian Black Menopausal status Postmenopausal Premenopausal Perimenopausal Breast sidedness Right Left Breast size Small (approximately A-cup) Medium (approximately B-cup) Large (approximately C-cup) Extra-large (approximately D-cup or greater) Neoadjuvant therapy Neoadjuvant systemic chemotherapy Neoadjuvant anti-estrogen therapy BCS, breast-conserving surgery lymph nodes and a subsequent completion mastectomy (with recurrence 7.5 and 6.5 months, respectively, after the original re-excision BCS procedure and subsequent completion mastectomy); and (3) a case of concurrent recurrence within the re-excision BCS site and multiple osseous metastases in an individual undergoing a re-exci- sion BCS procedure (with negative BCS margins) and evaluation of the axillary lymph nodes (with recurrence 15 months after the original re-excision BCS procedure). No isolated local recurrences within the treated breast alone have been identified. Of the eight known deaths identified during the study period, two deaths are from among the three cases of documented recurrent breast cancer described above, five deaths are secondary to pro- gression of other concurrent malignancies (including lung cancer in two cases, colon cancer in one case, lymphoma in one case, and leukemia in one case), and one death is from other (i.e. non-oncologic) causes. Discussion The determination of the adequacy of BCS has long been debated among clinicians involved in the management of invasive breast cancer [8-17]. Central to this ongoing debate has been the definition of "adequate" or "nega- tive" surgical resection margins, as well as the determina- Number (percentage or range) 57 (27 – 87) 65 (54 – 72) 175 (96 – 342) 29.6 (16.6 – 58.7) 175 (86%) 29 (14%) 154 (76%) 43 (21%) 7 (3%) 98 (48%) 106 (52%) 17 (8%) 82 (40%) 76 (37%) 29 (14%) 30 (14.7%) 24 (11.8%) 6 (2.9%) Page 8 of 23 (page number not for citation purposes)