Breast conserving therapy shows survival benefit compared to mastectomy in early-stage patients

When factoring in what is now known about breast cancer biology and heterogeneity, breast conserving therapy (BCT) may offer a greater survival benefit over mastectomy to women with early stage, hormone-receptor positive disease, according to research from The University of Texas MD Anderson Cancer Center.

The study findings defy the conventional belief that the two treatment interventions offer equal survival, and show the need to revisit some standards of breast cancer practice in the modern era.

The research was presented at the 2014 Breast Cancer Symposium by Catherine Parker, MD, formerly a fellow at MD Anderson, now at the University of Alabama Birmingham.

In the 1980s, both US-based and international randomized clinical studies found that BCT and mastectomy offered women with early stage breast cancer equal survival benefit. However, those findings come from a period in time when very little was understood about breast cancer biology, explains Isabelle Bedrosian, M.D., associate professor, surgical oncology at MD Anderson.

"Forty years ago, very little was known about breast cancer disease biology - such as subtypes, differences in radio-sensitivities, radio-resistances, local recurrence and in metastatic potential," explains Bedrosian, the study's senior author. "Since then, there's been a whole body of biology that's been learned - none of which has been incorporated into patient survival outcomes for women undergoing BCT or a mastectomy.

"We thought it was important to visit the issue of BCT versus mastectomy by tumor biology," Bedrosian continues.

The researchers hypothesized that they would find that patients' surgical choice would matter and impact survival with tumor biology considered.

WOMEN AT HIGH RISK FOR BREAST CANCER

Women who have a very high risk of developing breast cancer may choose to have a preventive (or prophylactic) mastectomy to reduce the risk of breast cancer.

You may be more likely to get breast cancer if one or more close family relatives has had the disease, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may help show that you have a high risk.

Prophylactic mastectomy should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and loved ones.

Mastectomy greatly reduces the risk of breast cancer, but does not eliminate it.

Risks

Scabbing, blistering, or skin loss along the edge of the surgical cut may occur.

Risks when more invasive surgery, such as a radical mastectomy, is done are:

Shoulder pain and stiffness. You may also feel pins and needles where the breast used to be and underneath the arm.. This swelling is not common, but it can be an ongoing problem. that go to the muscles of the arm, back, and chest wall.