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

Summary

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. (01/19/2016)

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

Relevance

This article is most relevant for Women with early stage breast cancer

Relevance Rating Details

Relevance: Medium-High

Strength of Science: Medium-High

Research Timeline: Post Approval

Media Ratings

Did you see the media coverage of this article?

See all media ratings.

How we rated the media

Who covered this study?

TIME

With early breast cancer treatment, less may be more: studies
This article rates 4.5 out of 5 stars

The Washington Post

Breast-conserving surgery plus radiation increases survival rates for women with early-stage cancer
This article rates 4.5 out of 5 stars

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Contents

At a glance In-depth
Findings     Limitations             
Questions for your doctor Resources  


STUDY AT A GLANCE

This study is about:

Whether survival is better for women with breast cancer who opted for breast-conserving surgery (surgery that only removes part of the breast, such as a ) 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 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 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 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 or other genes that are associated with an increased risk of a second breast cancer.

Posted 1/19/16

References

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

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Women with early stage breast cancer

This article is also relevant for:

people with triple negative breast cancer

people with ER/PR + cancer

people with Her2-positive cancer

people with breast cancer

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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 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 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 ) 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 , 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 mutation status of the women was not reported, so we do not know if carriers who had a higher risk of a second cancer opted for mastectomy.

Guidelines:

 

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 larger trial would be 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

Expert Guidelines
Expert Guidelines

The American Society of Breast Surgeons (ASBrS) provides practice guidelines for and mastectomy.

ASBrS recommendations for lumpectomy:

  • Current indications for breast-conserving surgery (BCS) are:
    • A biopsy-proven diagnosis of or invasive breast cancer that is clinically assessed as resectable (can be remove with surgery) with clear margins and with an acceptable cosmetic result.
  • Current contraindications for BCS:
    • Early pregnancy.
    • Multicentric tumor involving 2 or more quadrants of the breast.
    • Diffuse (widely spread) malignant/indeterminate microcalcifications.
    • Inflammatory breast cancer.
    • Persistently positive margins of excision (surgical margins are not clear of cancer cells).

ASBRrS recommendations for mastectomy:

  • Current indications for mastectomy:
    • Any cancer unsuitable for breast conservation, based on:
      • Large tumor-to-breast-size ratio
      • Multicentric tumor
      • Insufficient response to chemotherapy or endocrine therapy  
      • Persistently positive margins of excision
      • Inflammatory breast cancer
      • Extensive malignant/indeterminate microcalcifications
      • Early pregnancy
      • Proven or suspected inherited gene mutation 
      • Local recurrence following breast-conserving surgery and radiation therapy 
      • Patients with a contraindication to radiation 
    • For risk reduction in high-risk patients:
      • Proven or suspected inherited gene mutation 
    • History of prior mantle radiation  

Updated: 01/10/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • 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 ?

Peer Support
Peer Support

The following organizations offer peer support services for people with, or at high risk for breast cancer:

Updated: 05/07/2024

Related Resources
Related Resources

The following organizations have resources related to breast cancer. 

Updated: 05/22/2024

Who covered this study?

TIME

With early breast cancer treatment, less may be more: studies This article rates 4.5 out of 5 stars

The Washington Post

Breast-conserving surgery plus radiation increases survival rates for women with early-stage cancer This article rates 4.5 out of 5 stars

Health Day

Lumpectomy plus radiation may beat mastectomy for early breast cancer This article rates 4.5 out of 5 stars

General Surgery News

More evidence supports breast conservation over mastectomy This article rates 4.0 out of 5 stars

Medscape

Ten-year data: Lumpectomy and radiotherapy trump mastectomy This article rates 3.5 out of 5 stars

How we rated the media

Back to XRAY Home

Article Rating Details

TIME:  With Early Breast Cancer Treatment, Less May be More: Studies
Rating: 4.5 Stars

  • This article had one confusing fact/error. It said that the women who had brachytherapy developed fewer distant metastases. While it is true that the women who received lumpectomy also got radiotherapy, the study is still comparing breast conserving therapy and radiotherapy to mastectomy, not just looking at radiotherapy.

The Washington Post:  Breast-conserving Surgery Plus Radiation Increases Survival Rates for Women with Early-stage Cancer
Rating: 4.5 Stars

  • The headline should not be written so definitively because this study cannot conclude what the title claims.
  • This media article does do a good job with discussing some of the limitations, but it tends to bias towards lumpectomy definitively being better than mastectomy. It should emphasize more that this may not be the case for some groups, which is something this study did not look at.

Health Day:  Lumpectomy Plus Radiation May Beat Mastectomy for Early Breast Cancer
Rating: 4.5 Stars

  • This was a well-written media article.
  • This media article highlights that this “study doesn’t prove that lumpectomy and radiation give women a better chance than mastectomy does” and gives the reasons why. 

General Surgery News:  More Evidence Supports Breast Conservation Over Mastectomy
Rating: 4 Stars

  • This piece was not written for the general public. The majority of it is understandable, however, they do use terms that many people would not know.
  • This piece does not mention the limitations of the study.

Medscape:  Ten-Year Data: Lumpectomy and Radiotherapy Trump Mastectomy
Rating: 3.5 Stars

  • Headline is exaggerated—while the data show that lumpectomy may lead to higher survival, because of some flaws in the study design, it is not definitive. Therefore, saying lumpectomy ‘trumps’ mastectomy is not completely accurate.
  • This piece presented limitations of the study, which was good, but the limitations were not discussed in the context. For example, the two quotes in the quote boxes are actually contradictory as one says “the main take-away message is that breast-conserving therapy should be the treatment of choice.” While the other one says “radiation therapy may have played an important role in the difference in the outcomes.”

 

Study Rating Details

Relevance: Medium-High

  • This study is relevant for women who have early stage breast cancer.
  • This study provides additional support for lumpectomy and radiotherapy as an option in place of mastectomy mastectomy.
  • The results of this study are not guideline changing. 
  • The study had sample bias, the women who had breast conserving surgery tended to be younger and had a better prognosis than women who underwent mastectomy. 
  • This study did not take into account genetic testing for mutations in BRCA or other genes that would increase the risk of a second breast cancer. For women with inherited mutations, mastectomy may be the more appropriate surgery over lumpectomy.

Strength of Science: Medium-High

  • The study had significant limitations which affect the conclusions. These include sample bias and the fact that women who had breast conserving surgery also had radiation. 
  • This study did not take into account genetic testing for mutations in BRCA or other genes that would increase the risk of a second breast cancer. 

Research Timeline: Post-Approval

  • Outcomes from lumpectomy and radiation compared with mastectomy have been well-studied.