Survival improves with lumpectomy for stage I, II breast cancer

DURHAM, N.C. -- Patients with early stage breast cancer who were treated with lumpectomy plus radiation may have a better chance of survival compared with those who underwent mastectomy, according to Duke Medicine research.

The study, which appears online Jan. 28, 2013, in the journal CANCER, raises new questions as to the comparative effectiveness of breast-conserving therapies such as lumpectomy, where only the tumor and surrounding tissue is surgically removed.

“Our findings are observational but do suggest the possibility that women who were treated with less invasive surgery had improved survival compared to those treated with mastectomy for stage I or stage II breast cancer,” said E. Shelley Hwang, M.D., MPH, chief of breast surgery at Duke Cancer Institute and the study’s lead author.

Taking advantage of 14 years of data from the California Cancer Registry, a source of long-term outcome data for women diagnosed with and treated for breast cancer in California, the research team found improved survival to be associated with the less invasive treatment in all age groups, as well as those with both hormone-sensitive and hormone-resistant cancers. Women age 50 and older at diagnosis with hormone-sensitive tumors saw the largest benefit of choosing lumpectomy plus radiation: they were 13% less likely to die from breast cancer, and 19% less likely to die from any cause compared with those undergoing mastectomy.

Prior randomized trials have shown that when it comes to survival, lumpectomy with radiation is as effective as mastectomy in treating early stage breast cancer. As a result, the rate of women electing lumpectomy with radiation has climbed in the past few decades.

However, a recent trend has emerged with more early stage breast cancer patients, often younger women with very early cancers, opting for mastectomy. These women may perceive mastectomy to be more effective at eliminating early stage cancer and therefore reducing the anxiety accompanying long-term surveillance.

“Given the recent interest in mastectomy to treat early stage breast cancers despite the research supporting lumpectomy, our study sought to understand what was happening in the real world, how women receiving breast-conserving treatments were faring in the general population,” Dr. Hwang said.

The team analyzed data from 112,154 women diagnosed with stage I or stage II breast cancer between 1990 and 2004, including 61,771 who received lumpectomy and radiation and 50,383 who had mastectomy without radiation.

The researchers looked at age andNew Balance