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Does lumpectomy or mastectomy provide better survival for women with early stage breast cancer?


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Checked Special populations: women with early-stage breast cancer

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Previous research has hinted that women who have breast-conserving surgeries have the same, if not better, overall survival as women who have mastectomies. Researchers in this study wanted to see if that was true; they found that women who chose breast-conserving surgeries did have a higher overall survival. However, this study, presented at the 2015 San Antonio Breast Cancer Symposium, had limitations that make it difficult to interpret the results or to extend them to all women with breast cancer.


STUDY AT A GLANCE

This study is about:

Whether survival is better for women with early-stage breast cancer who opted for breast-conserving surgery (surgery that only removes part of the breast, such as a lumpectomy) compared to women who had mastectomies.

Why is this study important?

Knowing the positives and negatives of the surgical options for women who are diagnosed with early-stage breast cancer is important. For example, research has shown that women who have mastectomy and reconstruction have many more complications than women who opt for lumpectomy and whole breast irradiation.  Also, the cost of breast-conserving surgery is usually less than the cost of mastectomy. But which surgery has better survival? That is one of the most important things to consider when deciding on a surgical treatment.

Study findings: 

  1. Women who had breast-conserving surgery had increased 10-year survival compared to women who got mastectomies. 

What does this mean for me?

While this data is interesting, it does not change care guidelines for women with early-stage breast cancer. Women should still decide what surgery they want based on their personal preference and all of the characteristics of their cancer.  It is important to note that this study did not take into consideration whether or not the women had mutations in BRCA or other genes that are associated with an increased risk of a second breast cancer.

Questions to ask your health care provider:

  • How do I decide which surgery is right for me?
  • I have been diagnosed with breast cancer before age 50, should I consider genetic testing before deciding on mastectomy or lumpectomy?

IN DEPTH REVIEW OF RESEARCH

Study background:

Research from the 1980s showed that survival is the same after breast-conserving surgery with radiation therapy or mastectomy.  Current studies show that survival may be better for women who have breast-conserving surgery with radiation therapy.

In December 2015, Dr. Marissa van Maaren from the Netherlands Comprehensive Cancer Organization presented “Higher 10-year overall survival after breast conserving therapy compared to mastectomy in early stage breast cancer: A population-based study with 37,207 patients” at the San Antonio Breast Cancer Symposium. This study by Dr. van Maaren and her colleagues looked at the differences in survival between breast-conserving surgery and mastectomy.

Researchers of this study wanted to know:

What is the difference in 10-year overall and distant metastasis-free survival after breast-conserving surgery compared to mastectomy for women with early-stage breast cancer?

Population(s) looked at in the study:

This study used information about 37,207 women from the Netherlands Cancer Registry. Researchers selected women with a first primary breast cancer tumor (up to five centimeters, with no more than three positive lymph nodes) diagnosed between 2000 and 2004. About 58% of the women were treated with breast-conserving surgery and radiation therapy; the remainder had mastectomy without radiation. While all of the data from the women were used for the overall survival data analysis, only data from women who were diagnosed in 2003 was used for the distant metastasis-free survival data analysis.

Study findings:                                                              

  1. Women who had breast-conserving surgery had approximately 20% increased overall survival compared to women who had mastectomy.
  2. Women with small tumors that had not spread to the lymph nodes, and had breast-conserving surgery had a better 10-year distant metastasis-free survival rate than those who had mastectomy.

Limitations:

The researchers noted that overall, patients in the breast-conserving surgery group were younger and had more favorable prognoses, which may have influenced the study outcome. A bigger issue is that the breast-conserving surgery patients also had radiation therapy, while the mastectomy patients did not, so whether or not the increased survival rate was directly due to radiation therapy in the breast-conserving therapy group cannot be conclusively stated. Also, it is important to note that the BRCA mutation status of the women was not reported, so we do not know if BRCA carriers who had a higher risk of a second cancer opted for mastectomy.

Conclusions:

While this study supports previous data that says that overall survival is at least the same, if not better, with breast-conserving surgery, not enough conclusive proof exists to change guidelines. A large controlled trial where researchers randomize which women get which surgery and ensure that one group is not getting extra treatment (in this case, radiation therapy for the breast-conserving surgery group) is needed to determine which surgery provides better survival. Some patients may benefit much more from mastectomies than others, and some may benefit more from breast-conserving surgery. More work needs to be done to tease out these results. 

Posted 01/19/16

References

van Maaren M, et al. “Higher 10-year overall survival after breast-conserving therapy compared to mastectomy in early-stage breast cancer: A population-based study with 37,207 patients.” Presented December 2015 at the San Antonio Breast Cancer Symposium. 

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