I am surprised that so few women received adjuvant systemic therapy in this study. Systemic adjuvant therapy has been conclusively shown to decrease the risk of metastatic disease. Oncologists agree that the initial tumor stage as determined by size, differentiation, ER status and nodal status, is the major determinant of the risk of micrometastatic disease and the possibility of subsequent metastasis. These prognostic factors guide our recommendations concerning adjuvant therapy. Nonetheless, we strongly support our surgeons attaining negative margins in patients with breast cancer.
Negative margins are essential to decrease the risk of local recurrence.