According to two recent articles published in The New England Journal of Medicine, long-term survival appears equivalent in patients with early-stage breast cancer who are treated with either breast-conserving therapy plus radiation or a mastectomy. These data confirm results from previous trials indicating the efficacy of breast-conserving therapy for patients with early-stage breast cancer.
Early-stage breast cancer refers to cancer that is confined to the breast and axillary (under the arm) lymph nodes and has not spread to distant sites in the body. Previous studies have indicated that a breast-conserving therapy such as a lumpectomy (removal of the cancer with a surrounding margin of healthy tissue and some axillary lymph nodes) or quadrantectomy (removal of cancer and surrounding healthy including muscle and skin as well as axillary lymph nodes) plus radiation to the breast appears to be just as effective as a mastectomy (removal of entire breast, axillary lymph nodes and muscle) for patients whose cancer has not spread outside the breast. However, researchers have been anxious to analyze long-term data comparing these two treatment modalities.
The first clinical trial reported in The New England Journal of Medicine involved over 700 women diagnosed with breast cancer that was 2 centimeters or less between 1973 and 1980. Three hundred-forty nine patients were treated with a mastectomy and 352 patients were treated with a quadrantectomy plus radiation. In this study, patients from both groups who were diagnosed with cancer spread to the axillary lymph nodes after 1976 were treated with subsequent chemotherapy including cyclophosphamide (Cytoxan®), methotrexate and fluorouracil (5-FU). Approximately 20 years following treatment, 8.8% of patients treated with breast-conserving therapy plus radiation experienced a cancer recurrence in the same breast, compared to only 2.3% of patients treated with a mastectomy. However, there were no significant differences between the groups in terms of developing breast cancer in the other breast, cancer spread to distant sites in the body, or the development of a different type of cancer. In addition, the rate of death from breast cancer was 26.1% for patients treated with breast-conserving therapy, compared to 24.3% for patients treated with a mastectomy. From this data, these researchers concluded that breast-conserving therapy was the treatment of choice for patients with early-stage breast cancer
1.The second clinical trial reported in The New England Journal of Medicine involved over 1,800 women diagnosed between 1976 and 1984 with breast cancer that was 4 centimeters or less in diameter with or without spread to the axillary nodes. Patients were treated with either a mastectomy, a lumpectomy plus radiation to the breast or a lumpectomy alone. Patients who had axillary involvement received subsequent chemotherapy with Alkeran® (melphalan) and fluorouracil (5-FU). Patients who underwent a lumpectomy and were found to have cancer cells on the edges of the removed specimen (positive margins) were ultimately treated with a mastectomy. Approximately 20 years following treatment, overall survival (approximately 46%) and disease-free survival (approximately 36%) were nearly equivalent between the three groups of patients. However, the rate of recurrences in or near the breast with the original cancer was only 14.3% of patients treated with a lumpectomy plus radiation, compared to 39.2% of patients treated with a lumpectomy alone. Researchers from this trial also concluded that breast-conserving therapy followed by radiation appears to be appropriate treatment for women with early-stage breast cancer who have no spread of cancer to the margins of the surgically removed specimen
1.Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.
The New England Journal of Medicine. 2002;347;1227-1232.
2.Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.
The New England Journal of Medicine. 2002;347:1233-1241.
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