Lumpectomy as Effective as Mastectomy

20-year study shows length of life is the same, if breast cancer is caught early

(HealthDay is the new name for HealthScoutNews.)

MONDAY, July 14, 2003 (HealthDayNews) -- Breast cancer patients who choose lumpectomy live as long as those who choose mastectomy, if their cancer is diagnosed early on, concludes a new study.

The report -- a 20-year study published in the Aug. 1 issue of the journal Cancer -- marks the third time in less than a year that a major long-term study has found that a woman need not lose her entire breast to ensure cancer survival, as long as the cancer is diagnosed early.

"Our study, one of only six worldwide and one of just two U.S. trials ever to look at this question in a prospective, randomized fashion, confirmed that there was no detectable survival difference between women with early stage breast cancer treated with mastectomy or breast conservation therapy which included radiation," says lead study author Dr. Matthew Poggi. Breast conservation therapy is also known as lumpectomy.

Even when a cancer did recur in the breast treated with lumpectomy -- requiring a follow-up mastectomy -- the women's lives were not in any greater danger, adds Poggi, a radiation oncologist at the National Institutes of Health's National Cancer Institute, where the research took place.

"There was not any detectable difference in disease-free survival," he says.

Lumpectomy involves removing the tumor, evaluating the auxiliary lymph nodes for signs of cancer, and following the surgery with radiation therapy for several weeks or months. Mastectomy involves total removal of the cancerous breast, and often several lymph nodes.

For breast surgeon Dr. Kimberly Van Zee, the findings are not only an encouraging endorsement of the safety and efficacy of breast conservation therapy, but they underscore the importance of regular mammograms and early detection.

"The increase in survival rates for breast cancer directly correlate with advances in mammography," says Van Zee, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City. "And I think this study offers important evidence that finding a breast cancer early can not only help save your life, it can also save your breast."

Before mammography, Van Zee points out, most breast cancers were found at such a late stage that breast conservation therapy was impossible.

"But today, the widespread use of screening mammography, plus improvements in the quality of that screening, means the average size of diagnosed tumors has progressively decreased over the last two decades," she says. "And that is what has made breast conservation therapy possible."

In addition to bolstering confidence in breast conservation therapy, the study also offers new evidence that radiation therapy -- almost always administered following lumpectomy -- does not result in an increased risk of either cancer in the healthy breast or heart disease, as once thought.

"If it did have these effects, it would have been reflected in the death rate -- and it was not," says Van Zee.

The study involved a comparison of diagnosis, treatment and survival data on 237 breast cancer patients. All were originally part of a National Cancer Institute randomized trial comparing mastectomy to breast conservation therapy that began some 22 years ago.

Over the following two decades, the women's health was carefully monitored for not only cancer recurrences, but also cancer-related and overall survival rates. Poggi's team then analyzed the data and compared the two groups of women.

The result: 58 percent of those who had mastectomy survived, compared with 54 percent who had breast conservation therapy -- a difference that Poggi says was not statistically significant.

In addition, disease-free survival between the two groups was similar as well -- 67 percent in the mastectomy group, 63 percent in the breast conservation group.

Although 22 percent of the women who chose breast conservation therapy did develop cancer again in the treated breast, 59 percent of those women were able to successfully thwart the cancer's spread with mastectomy. Their survival rates were then equal, once again, to the women who initially chose mastectomy.

"What this showed us is that even if your cancer recurs, your survival won't be affected," says Van Zee. However, she emphasizes this also means the need for vigilant and diligent breast exams for any woman who has had breast cancer.

As hopeful as these study results may be, Poggi says that keeping a breast is still a decision many cancer patients are hesitant to make.

"As a radiation oncologist, I often find myself in the position of explaining to a patient that a more aggressive surgical procedure does not necessarily mean that their chances of 'beating the cancer' are improved," Poggi says.

Van Zee adds: "I think women should always be told all their treatment options. But, hopefully, these three studies combined will give those that choose breast conservation therapy confidence in their choice so they don't have to spend their healthy time worrying if they made the right decision."

More information

Visit the American Cancer Society to learn more about breast conservation therapy and the need for early detection of breast cancer.

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