Many women choose mastectomy, despite being eligible for breast-conserving therapy
Breast-conserving therapy is proven successful in more than 90% of women who are eligible for the procedure after undergoing neoadjuvant chemotherapy; however, 31% of women eligible for breast-conserving therapy chose to have the entire breast removed via mastectomy.
This research on triple-negative breast cancer was presented at the American Surgical Association 135th Annual Meeting, in San Diego, California, and will be published in the Annals of Surgery pending editorial review.
No approved targeted therapies exist to treat triple-negative breast cancer, but new chemotherapeutic treatment strategies are helping shrink tumors so that less breast tissue needs to be removed during surgery.
"In general, if possible, we try to offer breast conserving therapy as a preferred option for women with early stage breast cancer," said corresponding author Mehra Golshan, MD, director of Breast Surgical Services at Dana-Farber/Brigham and Women's Cancer Center in Boston, Massachusetts.
"One of the reasons we use chemo first is to potentially allow women who originally needed to have the entire breast removed because of more advanced disease to now be eligible for breast conserving therapy. We see though that a significant number of patients who were eligible still ended up deciding to have their breast removed."
The new work does not explain why patients and their surgeons made this choice. Previous studies have found that the rate of survival for patients who were eligible for and chose to undergo breast-conserving surgery, such as lumpectomy, is the same as for those who chose to undergo mastectomy.
"We don't have an answer for why this is the case, but we hope that this work encourages more patients and clinicians to think about why this is happening and what we can do to address this," said Golshan.
The new study examined the impact of adding carboplatin and/or bevacizumab to the standard regimen of chemotherapy given to patients with triple-negative breast cancer. The team found a trend suggesting that the addition of one or both drugs increased the number of patients eligible for breast conserving therapy.
"In triple-negative breast cancer patients, we continue to increase the complete pathologic response rate with our new drug combinations," said senior author David Ollila, MD, of the University of North Carolina School of Medicine and a member of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill. "On our trial, more patients were eligible for breast preservation. Despite these advances, more patients chose mastectomy as their surgical procedure. The reasons for this paradox need to be further explored."
"A lot of things go into making this decision, but we must take into consideration the high likelihood of success in patients deemed candidates for breast conserving therapies," said Golshan.
Golshan and his colleagues note that they did not study specific patient or surgeon factors such as fear of cancer recurrence or whether a patient harbored genetic mutations. Future studies could shed light on how these variables impact the choice between mastectomy and breast conserving therapy.