Breast cancer

20 January 2014

Breast removal may not be best solution

A review has found that women who got breast-conserving surgery and radiation to treat early-stage cancer were less likely to die than those who had their breasts removed.

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A new review of a decade's worth of US cancer statistics finds that women who got breast-conserving surgery and radiation to treat early-stage cancer were less likely to die from breast cancer during the next 10 years than those who had their breasts removed.

Researchers found that 94% of women who had lumpectomy and radiation between 1998 and 2008 had not died of breast cancer after 10 years, compared to about 90% of the women who had mastectomy, with or without radiation.

"We can see what's happening in modern-day practice," Dr Shailesh Agarwal said. "Patients who are undergoing breast conservation therapy - versus patients who are undergoing mastectomy - are having better survival."Agarwal, an associate professor of plastic and reconstructive surgery at the University of Utah School of Medicine in Salt Lake City, is the study's lead author.

Read: New treatment for breast cancer

His team's report, published in the journal JAMA Surgery, is not the first to point out that women who have lumpectomy and radiation for breast cancer appear to live longer than others.

But research looking into whether women who have breast-conserving therapy have a higher risk of their cancer returning or spreading has yielded mixed results.

In January 2013, a study published in the journal Cancer found that Californian women who had lumpectomy were also more likely to survive longer than those who had their breasts removed.

 But older randomised controlled trials, considered the "gold standard" of medical research, have found that survival is about equal between women who undergo lumpectomy with radiation and those who have their breasts removed.

The study

For the new study, the researchers used data on more than 130 000 US women between the ages of 18 and 80 years old who were treated for early-stage breast cancer. That meant the tumour size was less than 4 centimetres and three or fewer lymph nodes showed signs of cancer cells having spread.

Overall, about 70% of the women underwent lumpectomy with radiation, about 27% had mastectomy and about 3% had mastectomy with radiation.

Results of the study

After five years, about 97% of women who had lumpectomy with radiation had not died of breast cancer. That compared to about 94% of women who had mastectomy and about 90% of women who had mastectomy and radiation.

After 10 years, about 94% of women who had lumpectomy with radiation had not died of breast cancer. That compared to about 90% of women who had mastectomy and about 83% of women who had mastectomy and radiation.

Read: Breast cancer treatment side effects last for years

Analysis of the study

The researchers acknowledge in their report that they can't explain why people who have breast conservation therapy are less likely to die of breast cancer, compared to those who have their breasts removed.

It could be, they write, that there are differences in the other therapies they received, such as chemotherapy, or the aggressiveness of a woman's tumour, that were not reflected in the data.

The differences between the women who chose one therapy over another

There could also be differences between the women who chose one therapy over another, including unrelated health problems, lifestyle, family history and other variables.

When researchers compared women with similarly-sized tumours and similar lymph node involvement, for example, race appeared to play a role in survival, with African American women nearly twice as likely to die from the cancer.

Women who had mastectomy and radiation were also typically younger with more advanced breast cancer, which may partially explain why they were most likely to die of breast cancer over 10 years, Agarwal and his colleagues write.

But when women with similar tumours and other variables were compared, overall, the women who had lumpectomy with radiation still had a lower chance of dying than those who had mastectomy.

'Women should have frank discussions with their doctors'

Agarwal said that it's also important for women to have frank discussions with their doctors about treatments."Despite this being a large database study and a large number of patients, breast cancer treatment is highly individualised," he said.

"I think the main thing is to have good discussion with your breast surgeon and even the multi-disciplinary (treatment) team so that you have the best chance of getting the optimal treatment."


Read more:

Breast cancer treatment may lead to hip fracture

Obese women face breast cancer risk


 

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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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