Dr. C. Joseph Bennett, Navigating Cancer, 02/05/13

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Breast-conserving therapy beats mastectomy in early breast cancer

By Dr. C. Joseph Bennett

Decades ago, when a woman was diagnosed with breast cancer, her only chance of survival included a surgical procedure called a radical mastectomy. Over time, this procedure evolved to what is called a modified radical mastectomy, with equal results.

Then research studies carefully explored the possibility of a lesser surgical procedure, simply removing the tumor and preserving the rest of the breast, called a lumpectomy.

This lumpectomy, when followed by radiation therapy, led to equivalent cure and survival rates for women with breast cancer, and opened the door for a woman to keep her breast if she chose to.

For the past 20 years, when I have seen a woman newly diagnosed with breast cancer, I have always discussed both surgical options and explained the cure and survival rates of the two are the same; it really is a personal choice.

Now, I may have to re-think that philosophy.

In a new study released only a few weeks ago, women with early stage breast cancer who undergo a lumpectomy followed by radiation therapy such as we deliver at RBOI, were found to have a better survival rate than women who underwent the more surgically aggressive mastectomy. The details of this study were published online in Cancer.

Researchers from the Duke University Medical Center in Durham, N.C. analyzed survival data from 112,154 women who had been diagnosed with stage I or stage II breast cancer in California between 1990 and 2004.

They carefully compared those women who had received either a mastectomy or breast-conserving therapy (BCT, also known as a lumpectomy) along with a course of radiation therapy. During this study, there were 31,416 deaths as of 2009, with breast cancer directly being the underlying cause in 39 percent of cases.

During an average follow-up of 110.6 months, researchers found that women who received BCT followed by radiation therapy had significantly improved overall survival, meaning that fewer women in the BCT and radiation arm of the study had died from all causes combined, not just cancer.

BCT followed by radiation therapy was also associated with significantly improved disease-specific survival — yes, fewer women dying from breast cancer when compared to the mastectomy, with a greater benefit for women age 50 years or older with hormone receptor-positive cancer than among women aged younger than 50 with hormone receptor-negative disease.

However, in all subgroups of patients analyzed, older or younger than 50, hormone receptor positive or negative, this finding of a better survival rate among women who underwent BCT followed by radiation therapy was observed.

So, this adds even more data to the success of the lumpectomy when followed by radiation therapy when looking at patients with early stage breast cancer. This study clearly shows BCT followed by radiation therapy was associated with improved disease-specific survival.

Overall, this data should provide confidence and a sense of comfort to women that BCT followed by radiation therapy is an effective alternative to mastectomy for early stage disease regardless of age or hormone receptor status, and will allow more and more women to keep their breast, cure their cancer and actually improve their chances of survival when compared to a mastectomy.

Dr. C. Joseph Bennett is a board-certified radiation oncologist and a member of the Citrus County Unit of the American Cancer Society. Watch “Navigating Cancer” on WYKE TV at 7:30 p.m. Tuesdays and at 10 a.m. Thursdays. If you have any suggestions for topics, or have any questions, contact him at 522 N. Lecanto Highway, Lecanto, FL 34461, or email cjbennett@rboi.com. ­