Lumpectomy Plus Radiation May Offer Survival Benefits Over Mastectomy for Early-Stage, Hormone-Receptor-Positive Disease

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Many studies done in the 1970s showed that lumpectomy plus radiation to treat women diagnosed with early-stage breast cancer offered the same survival rates as mastectomy. Based on these studies, the U.S. National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation was preferred over mastectomy to treat early-stage breast cancer.

These studies were done about 40 years ago, before we knew as much as we do now about all the characteristics of breast cancer. So researchers wanted to know if considering the hormone-receptor status of a breast cancer would affect survival rates for lumpectomy plus radiation versus mastectomy. So they decided to do a new study.

The results suggest that women diagnosed with hormone-receptor-positive early-stage breast cancer who have lumpectomy followed by radiation have slightly better survival rates than women who have mastectomy alone or lumpectomy alone.

The study was presented on Sept. 4, 2014 at the 2014 ASCO Breast Conference. Read the abstract of “Effect of hormone receptor status on local treatment and overall survival for early-stage breast cancer.”

The researchers looked at the health records of 16,646 women in the National Cancer Database who were diagnosed with stage I breast cancer and treated during 2004 and 2005. The National Cancer Database contains information from more than 1,500 cancer facilities and is sponsored by the American College of Surgeons and the American Cancer Society.

Of the women in the study:

  • 11,214 were treated with lumpectomy plus radiation
  • 3,587 were treated with mastectomy
  • 1,845 were treated with lumpectomy alone

The women were followed for about 7 years.

About 72% of the cancers were hormone-receptor-positive.

The researchers matched 1,706 women in each treatment group based on age and other personal characteristics and compared 5-year survival rates between the three groups. Survival rates were:

  • 93% for women who had lumpectomy plus radiation
  • 88% for women who had mastectomy
  • 86% for women who had lumpectomy alone

Then the researchers looked at survival rates by hormone-receptor status. Survival rates for women diagnosed with hormone-receptor-positive breast cancer were:

  • 90% for women who had lumpectomy plus radiation
  • 87% for women who had mastectomy
  • 81% for women who had lumpectomy alone

All of these results were statistically significant, which means that the differences are probably because of the differences in treatments and not just due to chance.

So it seems that radiation makes a difference in survival when treating early-stage, hormone-receptor positive disease. Still, the design of the study may have had something to do with the outcome.

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 lumpectomy plus radiation, mastectomy alone, or lumpectomy alone. So the women who got mastectomy alone or lumpectomy alone 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
  • 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 with or without radiation -- 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 Mastectomy vs. Lumpectomy page.

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