Breast-conserving surgery (BCS) without adequate margin clearance carries a high risk of local recurrence. We introduced cavity shaving at primary surgery 31 months ago, to assess tumor margin involvement. The aim of this study was to determine how cavity shaving affects the re-excision rate. We compared a group of 394 patients who underwent BCS with cavity shaving of macroscopically clear margins at primary operation, from March 2003 to September 2005 with a group of 392 patients who underwent BCS only from January 2000 to February 2003. Cavity shaves and re-excision specimens were measured and oriented with reference to the primary cancer. Pathological results of all the specimens were analyzed and re-excision rates in both groups were recorded. Compared with BCS alone where 49 of 392 patients (12.5%) required reoperation for margin clearance, only 22 of 394 patients (5.58%) of the group who had concurrent cavity shaves required further surgery (p < 0.01). Analysis of re-excised specimens suggests that reoperation could have been avoided in 44 of 49 patients, if they had standard sized cavity shave at primary operation. We conclude that cavity shavings during primary BCS significantly reduce the re-excision rate to ensure microscopic clearance.

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Ann R Coll Surg Engl 2008; 90: 69-71 69The 2-week wait for breast cancer was introduced by the UK Government on 1 April 1999. 1 This initiative was recognised in the NHS Cancer Plan and further targets were subsequently incorporated. 2Ever since the inception of 2-week wait, numerous studies have been conducted looking at various aspects of this service. [3][4][5][6][7][8][9][10][11][12][13][14] Published data suggest that the 2-week wait system and triple assessment at one fast-track clinic visit is an out-dated method of identifying disease in a referral population. These studies report up to 32% of the breast cancer coming from routine referrals. 11It has been concluded, therefore, that all patients should be seen within 2 weeks by 2008. 15 Patients and MethodsThe Birmingham Heartlands and Solihull fast-track clinics were set up in 1999 with a prospective audit system. The data collected in this audit included mode of referral ( i.e. routine versus fast-track) and adherence to the referral criteria (appropriateness). These data were retrospectively analysed and cross-referenced with the cancer data base to obtain the final diagnosis ( i.e. cancer versus non-cancer).Referral criteria for the fast-track breast clinics are available to general practitioners (GPs) referring breast patients to our hospital. The appropriateness of the referral was adjudged by the examining clinician in view of the referral criteria.Data were collected from November 1999 to February 2005. Statistical analysis was performed using the chisquared test and significance accepted if P < 0.05. ResultsA total of 14,303 patients were seen over this period. Out of these, 46.7% ( n = 6678) of the referrals originated from fasttrack and the remainder 53.3% ( n = 7625) came via routine referrals.The median age for referrals was 48 years and 40 years for fast-track and routine referrals, respectively. Published data suggest that the 2-week wait system and triple assessment at one fast-track clinic visit is an out-dated method of capturing disease from a referral population. These studies report up to 32% of breast cancer coming from routine referrals. It has been recommended, therefore, that all breast referrals should be seen within 2 weeks. The sheer volume of referrals are likely to prevent this target being achieved. The aim of this study was to analyse the performance of our fast-track system. BREAST CANCER Ann R Coll Surg Engl

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