Nav: Home

Is breast conserving therapy or mastectomy better for early breast cancer?

April 29, 2016

Turin, Italy: Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT). This is because there is little evidence as to whether the greater risk of a return of the disease at the site of the original tumour after BCT is linked to a greater risk of the cancer spreading to other parts of the body, leading to higher death rates.

Now, new research presented at the ESTRO 35 conference today (Saturday) has shown women aged younger than 45 years, who had early stage breast cancer that had not spread to the lymph nodes and who opted for BCT with radiation therapy, had a 13% higher risk of developing a local recurrence of their disease over a 20-year period than women who had a mastectomy and no radiation therapy. Furthermore, local recurrence doubled the risk of the cancer spreading elsewhere in the body (metastasis) and the risk of death was approximately two-thirds higher for BCT patients compared to mastectomy patients.

By contrast, among women aged over 45 there was no link between local recurrence and the risk of metastasis, and there was no difference in the proportion of these women who died after BCT or mastectomy.

Researchers from Aarhus University Hospital (Aarhus, Denmark) followed 1076 Danish women for 20 years [1]. The women had been diagnosed between 1989 and 1998 and were classified as low risk because they had tumours smaller than 5cms in diameter and the cancer had not started to spread to the lymph nodes. A total of 364 women received BCT and 712 had a mastectomy. None of the women received systemic therapies, such as chemotherapy, as they were classified as low risk and, at that time, systemic therapy was considered to have no beneficial effect.

After 20 years, the proportion of local recurrences was 18% after BCT (66 women) and 6.7% after mastectomy (55 women). Among the women who had a mastectomy, most local recurrences occurred in the first five years in the older women, and in the first ten years for the younger women. BCT patients of all ages had a local recurrence of their disease throughout the 20-year period.

Dr Tinne Laurberg (MD) said: "We found that among patients older than 45 years, receiving BCT, local recurrence was not associated with distant metastasis and the 20-year mortality was not different between BCT and mastectomy. These findings are in line with long-term data reported from several randomised trials, confirming that it is safe to offer older, lymph-node negative patients breast conserving therapy and adjuvant radiation therapy.

"In contrast, among the patients younger than 45 years, local recurrence was associated with distant metastasis, and young patients treated with BCT had an increased risk of death during the 20 years, either from their disease or from other causes, compared to those who underwent mastectomy.

"When future treatment guidelines of young lymph-node-negative patients are refined, the possibility of the negative impact of BCT on survival in these younger women should be taken into account."

Dr Laurberg said that her study was unusual not just for its large size but also because of the high proportion of young women included in it. "Data concerning the long-term effect of BCT versus mastectomy among young patients is very limited. In six randomised controlled trials comparing mastectomy and BCT all studies had a low proportion of young breast cancer patients included (between 12-23%), making it hard to draw any conclusion for this sub-group. Few cohort studies, restricted to young breast cancer patients, have been published, but these are limited by the inclusion of a mixture of different cancer stages, by the variety of adjuvant systemic treatments used, and by an average follow-up time of less than ten years in almost all of the studies. In contrast to former studies, our study of young breast cancer patients was unbiased, all patients were lymph-node negative, they received only BCT or mastectomy and we had complete 20-year data on local recurrence and overall survival."

President of ESTRO, Professor Philip Poortmans, who was not involved in the research, commented: "After the recent presentation of data that strongly support the use of BCT for all patients with early stage breast cancer, this study points us to the importance of obtaining and maintaining an optimal local tumour control because local recurrences appear to be a source for development of subsequent distant metastases. We have to view this from the right perspective though, as we have witnessed a remarkable decrease in the rate of local recurrences after BCT, even for young patients. On the other hand, these results might also be a warning signal about the possible risks associated with the recent trend towards the use of less aggressive breast cancer treatments, particularly those aimed at the area of the primary tumour."
-end-
Abstract no: OC-0052, "Long-term age dependent failure pattern after BCT vs. mastectomy in low-risk breast cancer patients", Proffered papers session, Clinical 1: Breast, 10.45-11.45 hrs CEST on Saturday 30 April, Auditorium.

[1] The patients were enrolled by Danish Breast Cancer Group (DBCG). [2] The study was funded by the Danish Cancer Society and CIRRO (Danish Centre for Interventional Research in Radiation Oncology).

European Society for Radiotherapy and Oncology (ESTRO)

Related Cancer Articles:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
New analytical technology to quantify anti-cancer drugs inside cancer cells
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
Leading cancer research organizations to host international cancer immunotherapy conference
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.

Related Cancer Reading:

The Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee (Author)

Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, The Emperor of All Maladies is a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.

Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly... View Details


The Truth about Cancer: What You Need to Know about Cancer's History, Treatment, and Prevention
by Ty M Bollinger (Author)

Cancer touches more lives than you may think. According to the World Health Organization, one out of three women alive today, and one out of two men, will face a cancer diagnosis in their lifetime.

To Ty Bollinger, this isn’t just a statistic. It’s personal. After losing seven members of his family to cancer over the course of a decade, Ty set out on a global quest to learn as much as he possibly could about cancer treatments and the medical industry that surrounds the disease. He has written this book to share what he’s uncovered—some of which may shock you—and to give you... View Details


Anticancer: A New Way of Life
by David Servan-Schreiber MD PhD (Author)

The revolutionary, New York Times bestselling guide to the powerful lifestyle changes that fight and prevent cancer—an integrative approach based on the latest scientific research
 
“A common-sense blueprint for healthy living.” —Chicago Tribune
 
“Resonating with cancer support communities and recommended nationwide.” —Los Angeles Times
 
“Life affirming . . . filled with practical advice.” —The Seattle Times
 
David Servan-Schreiber was a rising... View Details


Outside the Box Cancer Therapies: Alternative Therapies That Treat and Prevent Cancer
by Dr. Mark Stengler (Author), Dr. Paul Anderson (Author)

Naturopathic medical doctors Mark Stengler and Paul Anderson focus on the most critical components of Integrative Oncology Care. Using an accessible, case-history approach, they explore the different types of cancer, the causes of cancer, how proper nutrition can help prevent and treat cancer, the most well-studied supplement to use with cancer treatment, cutting-edge therapies (such as intravenous high dose vitamin C and other studied therapies), and natural solutions to common problems (such as the side effects of chemotherapy and radiation). View Details


F*ck Cancer: A totally inappropriate self-affirming adult coloring book (Totally Inappropriate Series) (Volume 4)
by Jen Meyers (Author)

*A portion of the proceeds from this book will be donated to support research dedicated to finding a cure for cancer. Because fuck cancer.

This book is for you.

If you are fighting cancer, this is for you. If your brother, sister, mom, dad, son, daughter, relative, or friend is fighting cancer, this is for you. If you've lost someone to cancer like I have, this is for you. If cancer affects your life in any way, this is for you.

The stress of cancer can feel crushing. But perhaps this book can help you get away from it all, if only for a little... View Details


The Cancer-Fighting Kitchen, Second Edition: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery
by Rebecca Katz (Author), Mat Edelson (Author)

This new and revised edition of the IACP award-winning cookbook brings the healing power of delicious, nutritious foods to those whose hearts and bodies crave a revitalizing meal, through 150 new and updated recipes.

Featuring science-based, nutrient-rich recipes that are easy to prepare and designed to give patients a much-needed boost by stimulating appetite and addressing treatment side effects including fatigue, nausea, dehydration, mouth and throat soreness, tastebud changes, and weight loss. A step-by-step guide helps patients nutritionally prepare for all phases of... View Details


The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies
by Dr. Nasha Winters ND FABNO L.Ac Dipl.OM (Author), Jess Higgins Kelley MNT (Author), Kelly Turner (Foreword)

The Optimal Terrain Ten Protocol to Reboot Cellular Health

Since the beginning of the twentieth century, cancer rates have increased exponentially―now affecting almost 50 percent of the American population. Conventional treatment continues to rely on chemotherapy, surgery, and radiation to attack cancer cells. Yet research has repeatedly shown that 95 percent of cancer cases are directly linked to diet and lifestyle. The Metabolic Approach to Cancer is the book we have been waiting for―it offers an innovative, metabolic-focused nutrition protocol that... View Details


Cancer: 50 Essential Things to Do: 2013 Edition
by Greg Anderson (Author)

The ground-breaking classic guide to surviving cancer?now completely updated!

Revised and updated for the first time since 1999, this invaluable guide to cancer recovery offers an easily accessible plan for patients and family members. Written by a cancer survivor, the book is an inspiring, action-oriented roadmap for those who choose to adopt a stance of hope and take charge of their diagnosis.

With penetrating insights that bring together more than two decades of scientifically supported research and experience, Anderson reveals a step-by-step holistic action plan... View Details


Radical Remission: Surviving Cancer Against All Odds
by Kelly A. Turner PhD (Author)

In her New York Times bestseller, Radical Remission: Surviving Cancer Against All Odds, Dr. Kelly A. Turner, founder of the Radical Remission Project, uncovers nine factors that can lead to a spontaneous remission from cancer—even after conventional medicine has failed.

While getting her Ph.D. at the University of California, Berkley, Dr. Turner, a researcher, lecturer, and counselor in integrative oncology, was shocked to discover that no one was studying episodes of radical (or unexpected) remission—when people recover against all odds without the help of... View Details


Tripping over the Truth: How the Metabolic Theory of Cancer Is Overturning One of Medicine's Most Entrenched Paradigms
by Travis Christofferson (Author), Dominic D'Agostino (Foreword)

With a new foreword by Dr. Dominic D'Agostino, PhD and epilogue by the author

 A masterful synchronization of history and cutting-edge science shines new light on humanity's darkest diagnosis.

In the wake of the Cancer Genome Atlas project's failure to provide a legible roadmap to a cure for cancer, science writer Travis Christofferson illuminates a promising blend of old and new perspectives on the disease. Tripping over the Truth follows the story of cancer’s proposed metabolic origin from the vaunted halls of the German scientific golden age to... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

The Person You Become
Over the course of our lives, we shed parts of our old selves, embrace new ones, and redefine who we are. This hour, TED speakers explore ideas about the experiences that shape the person we become. Guests include aerobatics pilot and public speaker Janine Shepherd, writers Roxane Gay and Taiye Selasi, activist Jackson Bird, and fashion executive Kaustav Dey.
Now Playing: Science for the People

#478 She Has Her Mother's Laugh
What does heredity really mean? Carl Zimmer would argue it's more than your genes along. In "She Has Her Mother’s Laugh: The Power, Perversions, and Potential of Heredity", Zimmer covers the history of genetics and what kinship and heredity really mean when we're discovering how to alter our own DNA, and, potentially, the DNA of our children.