Two long term U.S. and European studies confirm that breast cancer patients who have just their tumors cut out survive as long as those who have the entire breast removed. The researchers hope their work deters breast removal as a cancer cure when the alternative is possible.
The two separate studies began in the 1970s when researchers in Milan, Italy and the University of Pittsburgh started tracking a total of 2,500 breast cancer patients to see which treatment improved their survival rates.
Both studies compared the longevity of those who had a breast removal procedure called a mastectomy to those who had only their tumors removed, or lumpectomy, combined with radiation therapy. The U.S. study looked at a third group women who received a lumpectomy without radiation.
The earliest follow up data appearing in the 1980s showed that mastectomy a procedure favored through most of the 20th century offered no survival advantage. The results began to change the way surgeons treated breast cancer. More often, they chose strategies to preserve breast tissue.
Yet many women still get mastectomies either by choice or by physician recommendation.
Now, the 20-year results of the U.S. and Italian research are published in The New England Journal of Medicine and reaffirm the early findings. "Mastectomy should be becoming increasingly rare in the therapy of breast cancer," said Dr. Bernard Fischer.
This is Dr. Bernard Fisher, who led the U.S. study at the University of Pittsburgh. "I can say with assurance based upon the long term follow-up of this study that there is no biological or clinical evidence why most women cannot have a lumpectomy, provided they can have a good cosmetic result, and also that when the tumor is removed, there is a rim of normal tissue around it so that you are unlikely to be leaving tumor behind," he said.
Dr. Fisher's study of more than 1,800 women shows that after 20 years, about one-third were still alive without further breast cancer recurrence no matter what treatment they had mastectomy, lumpectomy, or lumpectomy with radiation.
The smaller Milan study of 700 women measures survival in a different way. It shows that in the groups who had either mastectomy or lumpectomy with radiation, the same proportion of each died of breast cancer after two decades about one fourth.
The two reports also show that tumor reoccurrence was low in that period of time.
A New England Journal of Medicine editorial by surgeon Monica Morrow of Northwestern University in Chicago says the studies should convince even the most determined skeptics that mastectomy is not superior to breast conservation for treating breast cancer.
Dr. Fisher is emphatic on that point. "The recommendations are the same as I have been talking about for 15 to 20 years," he said. "More people should be having breast preservation surgery."