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Breast conserving surgery is the best option for cancer.

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The results of two twenty-year randomised trials for breast-conserving surgery compared with the former standard of care have been published in the New England Journal of Medicine.

The first study compared conservative therapy with radical mastectomy for early breast cancer and the second compares total mastectomy with lumpectomy or lumpectomy plus irradiation.

Conservative therapy was shown to give better outcomes, and the second study supports the current standard of lumpectomy with irradiation as appropriate.

“The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy,” write Umberto Veronesi, MD, from the European Institute of Oncology in Milan, and colleagues. “Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers.”

From 1973 to 1980, the first study investigated 701 women with breast cancers 2 cm or smaller in diameter were randomised for treatment with Halsted radical mastectomy or with breast-conserving quadrantectomy followed by ipsilateral radiation therapy. Tumor recurrence in the same breast occurred in 30 women who had breast-conserving surgery and in eight who had radical surgery (20-year cumulative incidence, 8.8% and 2.3%; P<.001). However, there was no significant difference at 20 years in all-cause death rate (41.7% vs. 41.2%, P=1.0), nor in rate of contralateral breast cancer, distant metastases, second primary cancers, or in death rates from breast cancer (26.1% vs. 24.3%; P=0.8). The second study evaluated 20-year follow-up data from 1,851 women with invasive breast cancer randomised for treatment with total mastectomy, lumpectomy alone, or lumpectomy and breast irradiation. “Lumpectomy followed by breast irradiation continues to be appropriate therapy for women with breast cancer, provided that the margins of resected specimens are free of tumor and an acceptable cosmetic result can be obtained,” wrote Bernard Fisher, MD, and colleagues from the University of Pittsburgh in Pennsylvania. Cumulative incidence of ipsilateral recurrent tumor was 14.3% in the lumpectomy-irradiation group and 39.2% in the lumpectomy without irradiation group (P<.001). There were no significant differences among the three groups in overall, disease-free, or distant disease-free survival. Although radiation therapy was associated with a marginally significant decrease in deaths due to breast cancer, this decrease was partially offset by an increase in deaths from other causes. In an accompanying editorial, Monica Morrow, MD, from Northwestern University in Chicago, commends these studies and exhorts clinicians to put their findings to practical use. “If we do not apply (these findings) to the treatment of the women with breast cancer we see today, we will have made little or no progress over the past 20 years in the search for a rational approach to the local treatment of breast cancer,” she writes. “It is time to declare the case against breast-conserving therapy closed and focus our efforts on new strategies for the prevention and cure of breast cancer.” (Source: Medscape Medical News)

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Posted On: 22 October, 2002
Modified On: 3 December, 2013


Created by: myVMC