• Does local therapy choice improve survival?

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    Guest post by Komen Scholar Ann H. Partridge, M.D., M.P.H.

    Over the past decade, there has been a substantial increase in the number of women with early breast cancer who are choosing to undergo prophylactic contralateral mastectomy (e.g., removal of the healthy breast, usually in conjunction with mastectomy for the breast that has breast cancer), particularly among young women.  Reasons for this trend and whether it improves how women do in the long run are under active study.

    At the ASCO Breast Cancer Symposium in San Francisco last week, researchers from Canada used the Ontario Cancer Registry to compare outcomes between young women who underwent bilateral mastectomy and those who only underwent unilateral mastectomy.

    The study found that among 628 women age 35 or younger at diagnosis who underwent surgery for early breast cancer, those who had bilateral mastectomy (16 percent) did not experience better survival compared with women who underwent unilateral mastectomy.  The median follow-up was only 11 years, and other recent data have suggested that even among women with a known BRCA 1 or 2 mutation, who have a higher risk of developing a new breast cancer in the remaining breast in the future, the modest benefit may not be seen for several years. Further, it is possible that a subset of patients may experience benefit, emphasizing that further research to tease out different benefits for different types of breast cancer is needed.

    Another study presented at the conference and led by Catherine Parker, M.D., of the University of Alabama, compared outcomes among women who underwent mastectomy, breast-conserving surgery plus radiation, or breast-conserving surgery alone.  Prior studies comparing breast-conserving therapy (both with and without radiation) to mastectomy for early-stage breast cancer found no difference in patient outcomes. However, Parker and colleagues challenged this tenet when considering tumor subtype (e.g., triple negative, HER-2 positive, ER-positive), finding breast-conserving surgery plus radiation was significantly associated with longer survival, suggesting that type of local therapy makes a difference in survival rates.

    An analysis of breast surgery types within that study confirmed the survival benefit associated with breast-conserving surgery plus radiation among patients with hormone receptor-positive disease, but not among those with hormone receptor-negative disease. Additionally, breast-conserving surgery plus radiation was associated with longer survival than breast-conserving surgery alone, regardless of tumor type.

    These recent studies underscore our evolving understanding of how the type of surgery can affect outcomes for women with breast cancer, and that further research is definitely needed.  Moreover, they highlight the fact that when women have choices about how to treat breast cancer, they need information and support in order to make the best personal decisions.  When I discuss surgical decisions with my patients, especially given the growing body of research suggests that lumpectomy followed by radiation is as good as (if not better than) mastectomy which is as good as bilateral mastectomy in terms of overall survival for most women, I try to help them focus on what will make them feel best, both physically and emotionally, when they are into their survivorship. Findings like those presented at the ASCO meeting are important for both patients and physicians as they make treatment decisions, and I’m pleased to see continued progress in research that will help identify the best treatments for individual patients.

     

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