Lumpectomy Plus Radiation May Beat Mastectomy for Early Breast Cancer

Study suggests 21 percent greater odds of survival after 10 years

Thursday, December 10, 2015

THURSDAY, Dec. 10, 2015 (HealthDay News) -- Women with early stage breast cancer may survive longer if they opt for the less-extensive surgery called lumpectomy, followed by radiation, rather than a mastectomy, a new study suggests.

"I think these results offer women important information to discuss with their doctors when making a treatment decision for early stage breast cancer," said lead researcher Sabine Seisling, of the Netherlands Comprehensive Cancer Organization, in Utrecht.

Mastectomy removes the entire the breast, while lumpectomy involves removing only the tumor with some surrounding tissue. Some studies have suggested that women with early stage breast cancer have a better five-year survival rate after lumpectomy.

The new study, which included 37,000 Dutch women, found that the advantage may also extend to the longer term. Of nearly 22,000 patients who underwent lumpectomy plus radiation, 77 percent were still alive 10 years later. That compared with only 60 percent of women who'd undergone a mastectomy -- with no radiation, which is typical for early stage breast cancer.

There were key differences between the two groups, Seisling noted.

Women who chose lumpectomy and radiation were younger, and more likely to receive hormonal therapy. But even with those differences considered, women in the lumpectomy group were 21 percent more likely to be alive 10 years after treatment, the study showed.

Seisling was scheduled to present the findings Thursday at the annual San Antonio Breast Cancer Symposium. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

But at least one expert cautioned that the study doesn't prove that lumpectomy and radiation give women a better chance than mastectomy does.

"We do need to take the results with a grain of salt," said Dr. David Euhus, chief of breast surgery at Johns Hopkins Hospital, in Baltimore.

That's because the findings are based on a review of patient records. And, Euhus said, the study couldn't account for all of the factors that could have swayed each woman's treatment decision.

There have been clinical trials looking at the question, Euhus pointed out. Several trials that started back in the 1980s found that for women with early stage breast cancer, the outlook was similar whether they had a mastectomy or lumpectomy plus radiation.

So, Euhus said, the less-extensive surgery is at least comparable to a mastectomy. "This new study reaffirms that lumpectomy plus radiation is a good treatment," he said.

That's important, according to Euhus, because the number of women wanting a mastectomy, including double mastectomy, has gone up in the past decade. And recent research suggests that fear of a cancer recurrence is a big driver of that trend.

Yet in the current study, lumpectomy patients not only lived longer, but were also less likely to have a cancer recurrence in the lymph nodes near the breast, or at other sites in the body.

"Our hypothesis," Seisling said, "is that the radiotherapy kills any remaining cancer cells left after surgery."

Lumpectomy plus radiation may also carry fewer complications and lower costs, according to another study presented at the same meeting.

That's true, at least, when women opt for breast reconstruction after their mastectomy. Researchers led by Dr. Benjamin Smith of the University of Texas MD Anderson Cancer Center in Houston found that those women had nearly double the risk of complications -- such as infection and bleeding -- compared with women who underwent lumpectomy and radiation.

That study also found the average cost of mastectomy and reconstruction hovered around $89,000 for women with private insurance. That compared with just under $66,000 for women who underwent lumpectomy and radiation, the study revealed.

Ultimately, Euhus said, the treatment choice depends on more than statistics. Each woman's cancer is different, and every woman's comfort level with a particular treatment will be different.

"A cancer diagnosis takes away your sense of well-being," Euhus said. "Some women will feel that their well-being and peace of mind can only be restored with a mastectomy."

SOURCES: Sabine Seisling, Ph.D., senior researcher, Netherlands Comprehensive Cancer Organization, Utrecht; David Euhus, M.D., chief, breast surgery, Johns Hopkins Hospital, Baltimore; Dec. 10, 2015, presentation, San Antonio Breast Cancer Symposium, San Antonio, Texas

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