Chemotherapy Before Surgery Increases Likelihood of Lumpectomy

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Treatments given to weaken and destroy breast cancer before surgery are called neoadjuvant treatments. Most neoadjuvant treatments involve one or more chemotherapy medicines. Targeted therapy medicines, hormonal therapy, or radiation therapy also can be used as neoadjuvant treatments.

Neoadjuvant chemotherapy isn’t routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive. When neoadjuvant treatment dramatically shrinks a cancer, lumpectomy instead of mastectomy may be an option for some women.

Based on what they were observing in their practices, doctors suspected that chemotherapy before surgery was increasing lumpectomy rates. But until now, no one had looked at national statistics.

Yale University researchers found that women with larger breast cancers who had chemotherapy before surgery were more likely to have lumpectomy than mastectomy.

The study was published online on Feb. 25, 2015 by the Journal of the American College of Surgeons. Read the abstract of "Neoadjuvant Chemotherapy for Breast Cancer Increases the Rate of Breast Conservation: Results from the National Cancer Database."

The researchers looked at records in the National Cancer Data Base, a database that is maintained by the American Cancer Society and the American College of Surgeons’ Commission on Cancer. The database includes information on about 80% of the cancers diagnosed in the United States.

Between 2006 and 2011, the researchers found that 354,204 women had been diagnosed with stage I to stage III breast cancer and treated with surgery and chemotherapy:

  • 59,063 of the women had chemotherapy before surgery
  • 295,141 had chemotherapy after surgery

The researchers found that the proportion of women being treated with chemotherapy before surgery steadily increased from 2006 to 2011:

  • 13.9% of the women had chemotherapy before surgery in 2006
  • 20.5% of the women had chemotherapy before surgery in 2011

Certain factors were linked to a woman being more likely to have chemotherapy before surgery:

  • the breast cancer was larger in size
  • cancer cells were in one to three lymph nodes
  • a woman being younger than 50
  • grade 2 or grade 3 cancer
  • the breast cancer was estrogen-receptor-negative

Overall, the study found that 35% of women who had chemotherapy before surgery had lumpectomy.

Women diagnosed with breast cancers that were larger than 3 cm (about 1.25 inches) who had chemotherapy before surgery were 70% more likely to have lumpectomy than mastectomy.

“We’ve seen data published from clinical trials showing that neoadjuvant chemotherapy results in increased lumpectomy rates, but this is really one of the first studies using a large national database that reflects what is also going on in the community hospital setting,” said Brigid Killelea, M.D., M.P.H., F.A.C.S., the lead investigator of the study.

The study didn’t look at overall survival among the women who had neoadjuvant chemotherapy. Previous studies have shown that there is no difference in overall survival between women who get chemotherapy before breast cancer surgery and women who get chemotherapy after surgery.

The researchers think that treatment advances, including the development of targeted therapies such as Herceptin (chemical name: trastuzumab), Tykerb (chemical name: lapatinib), and Perjeta (chemical name: pertuzumab) that are given along with chemotherapy medicines, have made neoadjuvant chemotherapy more effective in treating breast cancer.

Although most women who have a choice prefer less invasive lumpectomy surgery, there are many factors to consider when deciding between lumpectomy and mastectomy, including:

  • do you want to keep your breast?
  • do you want your breasts to match as much as possible in size?
  • if your whole breast isn’t removed, will you be extremely anxious about the cancer coming back?
  • where you live
  • where you go for treatment

If you’ve been diagnosed with breast cancer, you and your doctor will consider a number of factors when making treatment decisions, including:

  • your age
  • the size of the cancer
  • the grade of the cancer
  • the cancer’s hormone-receptor status
  • the cancer’s HER2 status
  • how many lymph nodes have cancer cells in them (if any)
  • your personal preferences

After discussing all the information and all your treatment options, you and your doctor can make the best treatment decisions for your unique situation.

For more information on the advantages and disadvantages of both lumpectomy and mastectomy, visit the Breastcancer.org Mastectomy vs. Lumpectomy page.



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