Breast-conserving surgery may top mastectomy for cancer survival

January 27, 2013 | by Roberta Nichols

Over the past decade, women with early-stage breast cancer have increasingly opted for mastectomy over lumpectomy despite evidence that breast-conserving therapy plus radiation is as effective as removal of the breast.

This trend has seemed particularly prevalent among younger, more affluent women from urban areas. New research suggests such decisions may be particularly unwise.

A microscopic image of breast cancer carcinoma. Many women with breast cancer in one breast choose to have the other breast removed as well. Shown here, a microscopic image of breast cancer carcinoma. (Credit: Duncan Smith)

In a study published online Monday in the journal Cancer, researchers found that  early-stage breast cancer patients who undergo breast-conserving therapy – lumpectomy and radiation – instead of mastectomy may actually live longer.

“In light of the reports showing renewed interest in mastectomy, and because there have been few opportunities to observe long-term, treatment-associated outcomes in the general population, we asked whether the comparable survival outcome of BCT compared with mastectomy as seen in randomized controlled trials could be generalized to the non-clinical trial population,” wrote lead author E. Shelley Hwang, M.D., M.P.H., Duke University Comprehensive Cancer Center.

"There are lots of women who think the more [treatment] they do, the better they will do," she told HealthDay News. "This refutes that."

Along with researchers from the University of California San Francisco Helen Diller Family Comprehensive Cancer Center and the Cancer Prevention Institute of California, Hwang and her colleagues studied data from women in the California Cancer Registry, the state’s population-based cancer surveillance system.

Investigators gathered data from 112,154 California women diagnosed with stage 1 or 2 breast cancer who were treated with breast-conserving therapy (BCT) or mastectomy between 1990 and 2004 and who were followed through December 2009. The cohort included 61,771 (55 percent) who received lumpectomy and radiation and 50,383 (45 percent) who had mastectomy without radiation.

“Long-term, breast cancer-specific survival after BCT was either equivalent or superior to mastectomy in all age groups and hormone receptor tumor types, with almost 10 years of median follow up,” researchers found.

Women 50 and older with hormone receptor-positive tumors fared the best, with 13 percent lower breast cancer mortality and 19 percent lower overall mortality with BCT than with mastectomy.

“These data provide confidence that BCT remains an effective alternative to mastectomy for early stage disease regardless of age or hormone receptor status,” wrote Hwang.

“Patients treated with mastectomy had a significantly lower overall survival rate and breast cancer-specific survival than women who underwent BCT, even after adjusting for tumor grade, proportion of positive nodes, race, SES, tumor size, age at diagnosis and year of diagnosis,” she added.

Laura Kruper, M.D., head of breast surgery service, and director, Rita Cooper-Finkel and J. William Finkel Women’s Health Center at City of Hope, confirmed the importance of the study.

“There have been studies published in recent years reporting that some groups of women with early-stage breast cancer had worse survival outcomes with BCT rather than mastectomy but this study demonstrates that is not true,” she said. Kruper was not involved in the study but called it “well-conducted, thorough and scientifically sound.”

“Mastectomy rates are currently increasing in the United States, mostly by patient choice,” Kruper continued. “We do not know all of the reasons why women choose mastectomy but ‘fear of recurrence’ is a motivating factor for many women. This study shows that for women with early stage breast cancer, choosing mastectomy will not necessarily improve their survival.”

Kruper’s own research also has shown that fear of recurrence has motivated many women to have a prophylactic mastectomy (removal of a breast unaffected by breast cancer) when they have breast cancer in the other breast.

“Hopefully, this study by Hwang, et al., will demonstrate to women with early-stage breast cancer that breast-conserving therapy is a good option and is associated with an improvement in survival,” Kruper added.

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