In the 1970s, cancer doctors began studying breast-conserving surgeries in breast cancer patients as an alternative to removing the entire breast and surrounding tissues and lymph nodes. These studies suggested that breast-conserving surgeries (such as lumpectomy) were as effective in treating breast cancer as the more aggressive mastectomies. Now researchers report on the survival of women in these studies 20 years later. Their research, published in the October 17, 2002
New England Journal of Medicine
, shows that long-term survival among women who underwent breast-conserving surgery is similar to those who underwent the more aggressive mastectomy procedures.
About the Study
In one study, researchers from the National Surgical Adjuvant Breast and Bowel Project (NSABP) and the University of Pittsburgh analyzed the latest data from an NSABP study begun in 1976. Women with invasive breast tumors of 4 centimeters (cm) or smaller entered the study between 1976 and 1984. These 1851 women were randomly assigned to undergo one of three surgeries: total mastectomy, lumpectomy, or lumpectomy followed by radiation treatment. Total mastectomy involved removal of the entire breast and nearby lymph nodes, whereas lumpectomy was simply removal of the tumor, some nearby tissue and fewer lymph nodes. After 20 years of follow-up, researchers compared the survival rates of women who underwent each procedure.
In a similar study, Italian researchers analyzed the latest data from a Milan Cancer Institute study begun in 1973. This study consisted of 701 women with breast tumors of 2 cm or smaller who entered the study between 1973 and 1980. The women were randomly assigned to undergo either radical mastectomy or a breast-conserving surgery followed by radiation therapy. Radical mastectomy involved removal of the breast, underlying muscle tissue, lymph nodes in the armpit, some skin, and fat tissue. The breast-conserving surgery was called quadrantectomy, which involved removal of the tumor and 2 to 3 cm of normal nearby tissue, as well as some muscle tissue, skin, and lymph nodes. After 20 years of follow-up, researchers compared the survival rates of women who underwent radical mastectomy with women who had the breast-conserving surgery.
The NSABP study found that disease-free survival rates were similar among the three groups—total mastectomy, lumpectomy, and lumpectomy followed by radiation. However, recurrence of breast cancer in the same breast was lower among women who had lumpectomy with radiation therapy than among women who had lumpectomy alone.
In the Italian study, survival rates were also similar in the two groups studied—radical mastectomy and the breast-conserving quadrantectomy. However, breast cancer recurred slightly more often in the quadrantectomy group compared to the radical mastectomy group.
Although these studies provide compelling evidence that aggressive surgeries to remove the entire breast and nearby tissues are unnecessary, the studies do have limitations. For example, the Italian study only included women with relatively small tumors. Larger tumors may not have responded so favorably to conservative management. In addition, breast cancer survival depends on more than tumor size, and the studies did not address other characteristics of the subjects and their tumors that may have predicted the aggressiveness of the disease.
How Does This Affect You?
Together, these two studies provide long-term evidence that breast-conserving surgeries, such as lumpectomy and quadrantectomy, produce survival rates similar to the more aggressive procedures. The radical mastectomy performed in the Milan study was virtually abandoned years ago, because shorter-term studies had shown it to be no more effective than less aggressive surgeries. However, total mastectomy as performed in the NSABP study is still done. In fact, Dr. Monica Morrow of Northwestern University School of Medicine points to research suggesting that nearly 30% of breast cancer patients are not even given the option of lumpectomy by their doctors.
The findings from the NSABP study are particularly important because they provide evidence that women who undergo lumpectomy are just as likely to survive the next 20 years as women who undergo total mastectomy. In addition, these results suggest that following lumpectomy with radiation therapy will reduce the likelihood of the cancer recurring at all.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.
Morrow M. Rational local therapy for breast cancer.
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