Research Suggests Lumpectomy Plus Radiation Leads to Better Survival for Early-Stage Breast Cancer but Questions Remain

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Lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk is about the same with either type of surgery.

A study suggests that in the real world, women diagnosed with stage I or stage II breast cancer who have lumpectomy followed by radiation have better survival rates than women who have mastectomy.

The study was published online on Jan. 28, 2013 by the journal Cancer. Read the abstract of “Survival after lumpectomy and mastectomy for early stage invasive breast cancer."

The researchers looked at the results of more than 112,150 California women diagnosed with stage I or stage II breast cancer between 1990 and 2004 who were treated with either lumpectomy plus radiation (55% of the women) or mastectomy (45% of the women). The women were followed through 2009.

The researchers compared overall survival rates and disease-specific survival rates between the two groups of women. Overall survival is how long the women lived, no matter what they died from. Disease-specific survival is how long the women lived before they died from breast cancer.

Overall survival was 19% higher for women who had lumpectomy plus radiation compared to women who had mastectomy. This suggested benefit wasn’t affected by the women’s age or the hormone-receptor-status of the breast cancer.

For women who had lumpectomy plus radiation compared to women who had mastectomy, disease-specific survival was:

  • 14% better in women who were 50 and older and diagnosed with hormone-receptor-positive disease
  • 7% better in women 50 and older and diagnosed with hormone-receptor-negative disease
  • 12% better in women who were younger than 50 and diagnosed with hormone receptor-negative disease
  • 6% better in women younger than 50 and diagnosed with hormone-receptor-positive disease

It’s not clear why women who had lumpectomy plus radiation had better survival rates than women who had mastectomy.

This study was a population-based study, which means the researchers used information that was collected before the study was planned. It also means that the women weren’t randomly assigned to get either lumpectomy plus radiation or mastectomy. So the women who got mastectomy may have had other health problems that may have affected the type of surgery they had. These other health conditions also may have affected their survival. Population-based studies aren’t considered as good as randomized clinical studies.

This study also didn’t look at:

  • the type of health insurance the women had (if any)
  • the distance to the nearest radiation treatment center
  • how many reconstruction surgeons were available to each woman
  • HER2 status of the cancer
  • whether the women had earlier radiation to the chest wall
  • the aggressiveness of the cancer
  • other health conditions (diabetes, circulatory problems, or a bleeding disorder, for example)

All of which are known to affect the lumpectomy vs. mastectomy decision-making process.

If you’ve been diagnosed with early-stage breast cancer, you and your doctor will talk about a surgical approach that makes the most sense for you and your unique situation. You will take into account a number of factors, including:

  • your preferences
  • any other health problems you have
  • ALL the characteristics of the cancer
  • how close you are to treatment facilities

Whichever surgery you choose – lumpectomy plus radiation or mastectomy – know that much research has shown that both are equally effective in removing early-stage breast cancer and reducing the risk of it coming back.

For more information on factors to consider when deciding on a type of surgery for early-stage breast cancer, visit the Breastcancer.org Mastectomy vs. Lumpectomy page.

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