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
"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.
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.
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.
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
Overall, about 70% of the women underwent
lumpectomy with radiation, about 27% had mastectomy and about 3% had mastectomy
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
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
cancer treatment side effects last for years
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
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.
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.
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
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