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Lumpectomy Plus Radiation May Offer Survival Benefits for Early-Stage Disease

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Many studies done in the 1970s showed that lumpectomy plus radiation to treat women diagnosed with early-stage breast cancer offered the same survival rates as mastectomy. Based on these studies, the U.S. National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation was preferred over mastectomy to treat early-stage breast cancer.

Over the last several years, some studies suggested that lumpectomy plus radiation offered better survival than mastectomy for women diagnosed with early-stage breast cancer, but the follow-up time for these studies was only 5 years.

A Dutch study with 10 years of follow-up also suggests that lumpectomy plus radiation may offer survival benefits for some women diagnosed with early-stage disease.

The study, “Higher 10-year overall survival after breast conserving therapy compared to mastectomy in early-stage breast cancer: A population-based study with 37,207 patients,” (Abstract S3-05) was presented on Dec. 10, 2015 at the 2015 San Antonio Breast Cancer Symposium.

Marisa Weiss, M.D., chief medical officer, discusses this study:

The researchers looked at the records of 37,207 women who were diagnosed with early-stage breast cancer in the Netherlands between 2000 and 2004:

  • 21,734 women (58.4%) had lumpectomy plus radiation
  • 15,473 women (41.6%) had mastectomy

In this study, only the women who had lumpectomy had radiation. In some cases, radiation may be given after mastectomy, especially if the tissue removed during mastectomy doesn’t have clear margins or if the cancer is more than one spot in the breast.

Overall, the women who had lumpectomy were younger and had more favorable cancer characteristics. Both of these factors would make it more likely that these women would have better survival compared to older women who had less favorable cancer characteristics.

After 10 years, overall survival rates were:

  • 76.8% for women who had lumpectomy plus radiation
  • 59.7% for women who had mastectomy

Overall survival is how long the women lived, whether or not the cancer came back.

The researchers did a second analysis that accounted for differences in factors that might affect overall survival, such as:

  • a woman’s age
  • whether or not a woman was treated with hormonal or targeted therapy after surgery
  • the grade of the cancer

The adjusted analysis also found that women who had lumpectomy plus radiation had higher overall survival rates.

The researchers found that disease-free survival was similar between the two groups. Disease-free survival is how long the women lived without the cancer coming back.

The researchers suspect that the radiation was the reason for the difference in overall survival.

“We think that radiation therapy may have played an important role in the difference in the outcomes from both treatments, although we cannot prove it with our data,” said Sabina Siesling, Ph.D., senior researcher at the Netherlands Comprehensive Cancer Organisation.

This study was a population-based study, which means the researchers used information that was collected before the study was planned. It also means that the women weren’t randomly assigned to get lumpectomy plus radiation or mastectomy. So the women may have had other health problems that might have affected the type of surgery they had. These other health conditions also may have affected their survival. Population-based studies aren’t considered as good as randomized clinical studies.

The study also didn’t look at:

  • HER2 status of the cancer
  • the distance to the nearest radiation treatment center
  • whether the women had earlier radiation to the chest wall
  • other health conditions the women may have had (diabetes, circulatory problems, or a bleeding disorder, for example)

All of the above factors can affect the lumpectomy vs. mastectomy decision-making process.

“Our study is not an absolute,” said Dr. Siesling. “We need to look at each woman’s individual situation and tailor the treatment to her. I want to stress that patients need to be given all the information available. The results of this study are part of that information.”

“I don’t think this study would change the current recommendations at this time,” said Carlos L. Arteaga, M.D., director of the Breast Cancer Program at Vanderbilt-Ingram Cancer Center and co-director of the San Antonio Breast Cancer Symposium.

If you’ve been diagnosed with early-stage breast cancer, you and your doctor will talk about a surgical approach that makes the most sense for you and your unique situation. You will take into account a number of factors, including:

  • your preferences
  • any other health problems you have
  • ALL the characteristics of the cancer
  • how close you are to treatment facilities

Whichever surgery you choose -- lumpectomy plus radiation or mastectomy with or without radiation -- know that much research has shown that both are equally effective in removing early-stage breast cancer and reducing the risk of it coming back.

For more information on factors to consider when deciding on a type of surgery for early-stage breast cancer, visit the Mastectomy vs. Lumpectomy page.

Read more Research News from the 2015 San Antonio Breast Cancer Symposium:

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