Mary Kay Barton
Potential survival benefit with lumpectomy for patients with early?stage breast cancer
recent study found women stage ii breast cancer breastconserving therapy bct associated improved diseasespecific survival compared mastectomy cancer 201311914021411 believed years 2 approaches locoregional treatment early breast cancer equivalent thus percentage women choosing bct increased however unclear reasons mastectomy chosen often among certain groups patients younger women situ cancer living affluent areas j clin oncol 201028e155e157 researchers set investigate whether similar survival rates bct mastectomy noted randomized trials hold true general population determine whether subgroup benefits one approach versus observational study 112000 women treated earlystage breast cancer women undergoing lumpectomy radiation equivalent subgroups superior breast cancerspecific survival compared women undergoing mastectomy says e shelley hwang md mph chief breast surgery duke university medical center durham north carolina dr hwang colleagues identified cases stage ii breast cancer california cancer registry patients diagnosed 1990 2004 women treated either lumpectomy followed radiation therapy mastectomy eligible women undergone lumpectomy without radiation mastectomy radiation excluded overall total 112154 eligible women found 55 underwent bct 45 underwent mastectomy median followup close 10 years bct rates increased 37 1990 1992 62 2002 2004 5year overall survival os rate entire cohort 893 diseasespecific survival dss rate 944 cox multivariate analysis performed compare survival 4 groups 1 aged 50 years older hormone receptor hrnegative disease 2 aged 50 years older hrpositive disease 3 aged younger 50 years hrnegative disease 4 aged younger 50 years hrpositive disease human epidermal growth factor receptor 2 her2 status considered widely available study period groups bct associated improved os compared mastectomy largest benefit observed group women aged older 50 years hrpositive disease hazard ratio 081 dss benefit also prominent group hazard ratio 087 smallest benefit bct noted women aged younger 50 years hrpositive tumors hazard ratio 093 large observational study recently compared outcomes mastectomy breast conserving therapy among women early stage breast cancer adjusting tumor grade percentage positive lymph nodes race socioeconomic status tumor size age diagnosis year diagnosis women treated bct still significantly higher os dss rates analysis performed examine whether comorbidities effect surgical choice outcomes heart disease chronic respiratory disease cerebrovascular disease considered bct associated significantly lower 3year mortality rates causes except breast cancer kaplanmeier survival estimates demonstrated statistically significantly increased os dss bct versus mastectomy analysis increased survival advantage bct found greatest among women aged 50 years older hrpositive disease examining tumor size surgical approach used survival benefit larger among patients t1 tumors compared t2 tumors groups os still better bct group among women t2 tumors dr hwang colleagues state strengths study include large diverse populationbased data set representing state california lengthy followup period excellent reliability data modern cohort randomized controlled trials comparing lumpectomy mastectomy conducted 30 years ago however study observational therefore groups randomized researchers tried control major factors known impact breast cancerspecific survival could unmeasured confounders associated choice mastectomy accounted analysis thus controlled study addition authors caution observational study causality could inferred study hwang colleagues shows benefit mastectomy measured risk local recurrence survival says stephen edge md chief breast surgery roswell park cancer institute buffalo new york findings survival better bct must interpreted caution randomized trial review suggests decisions made defining study population methodologic issues could biased results towards benefit bct benefit may may exist significant problem using population data however clearly showed worse outcome bct thereby reaffirming unequivocal findings randomized controlled clinical trials mature followup since data including study show mastectomy superior bct interesting recently reported trend showing increased uptake mastectomy bct women earlystage breast cancer reasons underlying trend doubtless multifactorial include better breast reconstruction techniques increased use mri increased awareness breast cancer consequences however trend particularly fascinating segment population opting surgerynot mastectomy bilateral mastectomyare generally younger educated women better access health care smaller earlier cancers indicates greater overall health literacy associated surgery despite lack evidence supports better outcome surgery says dr hwang dr edge agrees unknown reasons women asking surgeons performing mastectomies contributing factors include misinformation leading fear area thoughtful patient support needed surgery good treatment unfounded fears says future research could include examining relationship her2 status surgery outcomes data recorded california cancer registry since 2006 analysis possible study points importance large data sets used look questions randomized studies appropriate says dr hwang course always cases mastectomy better option women choice less may