TRIPLE POSITIVE GROUP
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MONDAY, Jan. 28 (HealthDay News) -- Breast-conserving surgery for early stage breast cancers may result in better survival than mastectomy, according to a new study.
For those with early stage breast cancer, "lumpectomy is just as effective if not more effective than mastectomy," said researcher Dr. Shelley Hwang, chief of breast surgery at Duke Cancer Institute in Durham, N.C.
"There are lots of women who think the more [treatment] they do, the better they will do," she said. "This refutes that."
The findings, published online Jan. 28 in the journal Cancer, are especially strong for women over 50 with hormone-sensitive cancers, the researchers found.
Earlier research had also concluded that the two procedures are similarly effective, but Hwang's is a more "real-world" study.
Hwang's team looked at 14 years of data from the California Cancer Registry, following more than 112,000 women with early stage breast cancer (stages 1 or 2) between 1990 and 2004. Ages ranged from 39 to 80.
More than half (55 percent) had lumpectomy and radiation, while 45 percent had mastectomy (complete breast removal) alone.
Hwang compared lumpectomy and radiation with mastectomy alone, not mastectomy plus radiation. "We wanted to look at early stage disease, and those patients typically don't get radiation after mastectomy," she said.
The researchers tracked the women's progress for a median of more than nine years (half followed longer, half less). During that time, more than 31,000 women died, nearly 40 percent of them from breast cancer. The others died of other causes.
For the first three years after treatment, those who had a mastectomy had a higher risk of dying from heart disease and other ailments than those who had lumpectomy. This may indicate that the women who underwent lumpectomy were generally healthier, Hwang said.
Over the entire follow-up, those who underwent lumpectomy were more likely to survive the breast cancer.
"The group that benefited the most -- who had the biggest difference in breast cancer survival -- were those women over 50 with estrogen-receptor positive disease," Hwang said. This means their cancer depends on estrogen to grow.
Among those women, the lumpectomy group had a 13 percent lower risk of death from breast cancer and a 19 percent lower risk of death from any cause than those who had a mastectomy.
Not all women with early stage breast cancers can have a lumpectomy, Hwang said. In this procedure, just the tumor and some healthy tissue are removed, sparing the rest of the breast. Among the exceptions are those whose cancers are too large, or those who have different cancers in the same breast.
The percent of women with early breast cancers choosing a mastectomy has risen recently, after a dip in previous years. Hwang and others suspect that women told they could safely opt for lumpectomy were still afraid to try it.
The new research, which was funded by the U.S. National Cancer Institute, suggests that if a lumpectomy is possible, it may actually increase survival, Hwang said.
The findings may reverse the mastectomy trend, said Dr. Laura Kruper, co-director of the breast oncology program at the City of Hope Comprehensive Cancer Center in Duarte, Calif., who was not involved in the study.
The study is scientifically sound in many ways, Kruper said. "They broke it down by year of diagnosis and by age category," she said. "They looked at socioeconomic status, and they kept it early stage."
Dr. Wendy Woodward, section chief for breast radiation oncology at the University of Texas MD Anderson Cancer Center in Houston, said that for women with early cancers, the study "clearly reiterates there is no detriment to cancer control in having a lumpectomy and radiation for breast-conserving surgery candidates."
But, Woodward added, "I am not sure the study convinces us that lumpectomy and radiation is better for breast cancer survival, but it may be."
The study was observational, Hwang stressed. It found a link or association but could not provide cause-and-effect proof that the breast-conserving treatment is more effective than mastectomy in early stage breast cancer.
Hwang believes the study does arm women with valuable information. However, "I don't want women who chose mastectomy to think they did the wrong thing," Hwang said. "At the end of the day, personal preference trumps everything else. I fully support the patient's options to choose the best treatment for themselves."
More information
To learn more about lumpectomy, visit the American Cancer Society.
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ang,
interesting study. The 40% death rate from bc isn't too cheering but I'm glad to see the reassurance re lumpectomies. I'm never sure what ot make of studies that lump so much data together -- I mean the MX people might have not had as good survival rates because, for ex., they got MX because of multiple areas of concern, for ex. But interesting. Thanks for posting.
Anyone heard from pbrain lately?
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cypher - I was thinking of her a few hours ago and wondering if she had been posting on any of the other threads.
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cypher not 40% died but of the women that did die, 40% of them were from breast cancer. So the overall
or
40% of 31,000 died of breast cancer but the study looked at 112,000 total women. So although 28% total died, only 40% of that 28% was from breast cancer.
Someone help me here with the math. I think that means only 7% of 112,000 died of breast cancer.
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I'm going to go with your figure, lago, because it feels better and I'm not up to maths. Even on good days!
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I agree, I want to go with Lagos number as the when I read earlier today it put me in a bad funk...
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You know guys my math might be correct. I was in AP math in high school and Jr. high. But then became an art/design major. I'm both left and right brained.
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You are fortunate, lago! I'm so right-brained (creatively speaking) that I think my head tilts in that direction. My husband, OTOH, is like you - right AND left brained. He's also a Mensa member. Ha ha. Opposites attract? Charity starts at home!
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THanks Lago, you're right. I mean that even though I WANT to mean that!
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Well someone here must know math. I really do want someone to confirm my numbers even though I know my logic is correct.
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I am an accountant without a creative bone in my body, and l agree. That is correct. Thanks for pointing that out, when I first read it, I also thought 40% died of breast cancer. Way to go, lago!
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BTW I'm not Mensa material but I can impress them at times.
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I sure can't!
ETA1: Too bad I can't blame chemo brain in whatever is the opposite of perpetuity! Retroactively, I guess.
ETA2: Last night I made the mistake of using the expression "diametrically opposed" - lol! I need Google glasses - especially during chemo.
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Good going Lago, sounds better to me too. Figures are better so it must be right.
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I don't BS about this stuff… and we have an accountant verification! So I can do math just can't spell or remember names..
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Ang,
Interesting study. But at this point, they can't link cause and effect...so I don't put a whole lot of stock in it. Could be accurate, could be totally off base. Especially since there are numerous studies that show lump/rads and MX have roughly the same survival/recurrence rate.
And now that radiation has been added to MX "early stage" cancer...it should up the numbers for MX.
Though this study doesn't consider node positive early stage...at least that's how I read it.
Either way though, true or doesn't pan out, I like knowing this stuff is being looked at again and again.
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pbrain last signed on on the 25th but has not posted since her last post on this thread.
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I'm following a Monday night Twitter social media discussion about breast cancer and an oncologist just tweeted this - which I thought I'm copy and paste here:
Interesting that Calorie restriction shuts/slows down the downstream effect of the Pathway that Herceptin affects (Beneficial) . #BCSM
Here's his Twitter description: @JediPD - Physician (Medical Hematologist-Oncologist), Pilot, Author, Educator, Husband, Father and Student
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Hi
I don't post often here but I follow along regularly.
I notice that in the study posts that Hwang said that they compared early stage lumpectomy with radiation with early stage mastectomy alone. She indicated that she did not compare with those who had mastectomy with radiation as radiation is not typically given after mastectomy for early stage breast cancer.
It makes me wonder whether the addition of radiation might be part of the reason for the better outcomes for the lumpectomy group and that maybe the mastectomy group would have benefited from radiation also. This seems like it might be backed up by the MA-20 study and the Vancouver study.
Interesting, thanks for posting.0 -
Yes, but there is no mention of BMX and chemo. So it has no meaning for me.
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The anchor on that study's report tonight also noted that there were many things not necessarily taken into account. I believe they also looked at all types of BS.
Lago....I had to laugh. When I looged on I glanced over the post, then saw the one on 40% and immediately went back to the article without reading further. I calculated it the same way you did. So, they are saying 10% died basically from breast cancer as I read it. That doesn't sound a lot different from what the actual statistics are, does it?
The RO I interviewed when making my decision, along with the BS both said they thought radiation would be overkill in my case, and that it is good to have it as an option if something should crop up.
Since today is my official two year anniversary for being NED, I am going to pretend that I didn't hear anything about that report and will wait five years until they come out with a better one.
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Lee, I've been hearing about caloric restriction (CR) for years (my dad works for the NIA and loves to talk science). Really interesting stuff there.
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cgesq....tatooing...I thought it hurt like mad. My PS numbed with Lidocaine and that hurt. Then, he started and all was ok until he hit an area that didn't take YOUCH!!! he had to stop and put in more lidocaine (ouch again) and then start. It was pretty much fine after that.
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However, I need a touch up and havent had the courage to go back. I am going to call Vinnie Myers tomorrow to see if he is touring around this area anytime this year.
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I just lost my first post ever at BCO thanks to fast-flying, careless fingers.
Starting over...
Bryona, if you're on Twitter you might like the Monday night breast cancer social media chat (6:00 pm every Monday night). The moderators/participants are great and the group is really growing. One of the moderators is my 2nd opinion breast surgeon (I met with her re: the node situation and she works with my oncologist - who is also Relda's oncologist). The hashtag, in case you're interested, is #BCSM.
ETA: Fluffqueen - congratulations on 2 years NED!
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LeeA, sadly I have never figured out twitter. ANyway that tweet said basically that calorie restriction helps or hurts the effectiveness of herceptin?
Re the study, it could be that women who are node positive, or who have relatives who have had bc, or other factors fuel their decision to have an MX rather than a lump, and so it might be self-selecting. If that made any sense. In other words, maybe these women are slightly higher risk for reasons that don't show up in the study, even though they are early stage.
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cypher -
helps - the way I read it.
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Fluff--congratulations on 2 YEARS NED--good sign.
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BTW I have been corrected. It appears that it is 11% not 7% but that's still a huge difference. I know my onc told me for my diagnosis and age there's a 14% chance of getting mets or dying in 10 years. I'm a stage IIB so if you figure in all early stage 11% makes sense.
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Oh, yeah, .4 * .28 = .11 I should never confirm without a calculator.
I might just sign up for twitter for that Monday night chat. I don't understand what you said though, is he saying that if you restrict your calories during herceptin, you won't get as much benefit from it?
Cypher, I think that is a good point. Women with more disease or more risk factors or some other negative factor may be more likely to choose MX over LX. It should be a randomized study to really draw conclusions from it.
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