Many women who are diagnosed with early stage breast cancer choose a breast conserving surgical treatment with lumpectomy. A lumpectomy preserves the majority of the breast by only removing the cancer and surrounding tissue, versus a mastectomy which is the complete removal of the affected breast. However, a recent study published in The Lancet reports that up to one fifth of women receiving breast conserving surgery may not be receiving the necessary follow up treatment needed to achieve an optimal chance for a cure.
Breast conserving surgery is an attractive treatment option for women with early stage breast cancer, producing comparable results to a mastectomy while sparing women from the complete removal of a breast. However, it is imperative for most women who decide on breast conserving therapy to receive follow up treatment in order to decrease their chance of a cancer recurrence by 50%. Follow up treatment consists of a lymph node biopsy to determine if the cancer has spread and radiation to kill any remaining cancer cells after surgery.
In a recent study, data was evaluated involving the treatment of almost 145,000 women who were diagnosed with early stage breast cancer between 1983 and 1995. The proportion of women not receiving adequate follow-up treatment (the omission of radiation, lymph node biopsy or both) following breast-conserving surgery has increased since 1989. By 1995, almost 20% of women in this study receiving breast-conserving surgery had not received appropriate follow-up treatment. It is important to note, however, that legitimate reasons which were not considered in the study, may contribute to the percentage of women who do not receive appropriate follow-up treatment. One reason may be that older patients do not have the necessary life span to consider a cancer recurrence a health risk, so further treatment would provide no benefit for them. Additionally, patients with other medical illnesses simply may not be able to tolerate the side effects of additional treatment. However, younger and otherwise healthy women deciding to receive breast-conserving therapy need to question their physician if appropriate follow-up treatment is not offered.
Since the risk of a cancer recurrence is doubled if follow up treatment is not administered after breast-conserving surgery, it is imperative that all women who choose breast-conserving therapy thoroughly discuss treatment strategies, potential side-effects of treatment and follow up schedules with their physician. In addition, women choosing breast-conserving surgery should educate themselves as much as possible about breast cancer, obtain second opinions from other physicians as well as seek opinions from specialists in chemotherapy and radiation. The addition of appropriate follow up treatment consisting of radiation and lymph node biopsies makes breast-conserving therapy an effective treatment option for women with early stage breast cancer, eliminating the need for a mastectomy.
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Women with breast cancer may also wish to discuss the risks and benefits of participating in a clinical trial further evaluating breast conserving treatment strategies or other promising new treatments for breast cancer. Sources of information on ongoing clinical trials that can be discussed with a doctor include comprehensive, easy to use services provided by the National Cancer Institute (cancer.gov) and eClinicalTrials.com. eClinicalTrials.com also provides personalized services on behalf of patients. (The Lancet, Vol 356, pp 1148-1153, 2000)
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