Expert Point of View: Harold Burstein, MD

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Harold Burstein, MD, Associate Professor of Medicine at Dana-Farber Cancer Institute, Boston, spoke to The ASCO Post about the multidisciplinary discussion of margin assessment during the 2014 Breast Cancer Symposium.

Should Oncologists Be Concerned?

“There is a real art to being a good pathologist. There are layers of sophistication that are invisible to other clinicians,” he said.  “Having said that, it is also clear that some of the historic rules about margin assessment were arbitrarily set. The need to achieve a certain margin threshold is the kind of dogmatic rule that probably doesn’t apply anymore.”

“Margins are related to recurrence, but the difference between ‘no ink on tumor’ and 1 mm, for example, is very small, and it’s easy to over-interpret these very tiny differences. In the modern era, where we have good imaging, good attention to surgical detail, good attention to radiotherapy and systemic drug therapy—those issues get even smaller,” Dr. Burstein said.

“The main thing is,” he said, “good breast cancer care is multidisciplinary. That means having a great pathologist working together with other clinicians.” ■

Disclosure: Dr. Burstein reported no potential conflicts of interest.


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