Lumpectomy better than mastectomy in early breast cancer

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In a recent analysis, women with stage I or II breast cancer who underwent breast-conserving therapy plus radiation exhibited higher rates of overall survival and disease-free survival than did women who had a mastectomy.

"The findings in this study should reassure women that among all age groups and tumor types, lumpectomy continues to be an excellent choice for women with small early breast cancers,” affirmed lead study author E. Shelley Hwang, MD, MPH, chief of breast surgery at Duke Cancer Institute in Durham, North Carolina, in a statement issued by Duke University Medical Center, also in Durham.

As the investigators noted, randomized trials have shown lumpectomy with radiation to be as effective as mastectomy as a treatment for early-stage breast cancer in terms of survival. Recent trends, however, have indicated that younger women with very early cancers have been opting for mastectomy. According to the Duke statement, these women may perceive mastectomy to be more effective at eliminating early-stage cancer and therefore reducing the anxiety accompanying long-term surveillance.

In the study by Hwang and colleagues, published by the journal Cancer, the investigators reviewed data from 112,154 women who had been diagnosed with stage I or II breast cancer in California between 1990 and 2004. Within this group, 50,383 patients had mastectomy without radiation and 61,771 had lumpectomy plus radiation. The women were followed for vital status through December 2009.

Less invasive treatment was associated with improved survival in all age groups, for both hormone-sensitive and hormone-resistant cancers. The greatest benefit was seen among women with hormone-receptor (HR)-positive tumors who were aged 50 years or older at diagnosis and had undergone lumpectomy with radiation: These patients had a 13% lower risk of death from breast cancer, and a 19% lower risk of death from any cause, than did women undergoing mastectomy.

In the first 3 years after surgery, women who underwent mastectomy were more likely to die of heart disease and other diseases than were women in the lumpectomy group, possibly signifying that the lumpectomy patients were generally healthier.

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