Some Women With Multiple Tumors in Same Breast Can Have Lumpectomy
Some women diagnosed with two or three early-stage breast cancer tumors in the same breast may be able to have lumpectomy and radiation, rather than mastectomy, according to a study.
The research was published online on March 28, 2023, by the Journal of Clinical Oncology. Read the abstract of “Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance).”
Multiple ipsilateral breast cancer
Ipsilateral means on the same side of the body, so multiple ipsilateral breast cancer means there is more than one area of cancer in the same breast. Doctors also call this type of cancer multiple ipsilateral foci of breast cancer. When multiple areas of breast cancer are multifocal, it means there is more than one area of cancer in the same quadrant of the breast. When these areas are multicentric, it means there are areas of cancer in more than one quadrant of the breast.
Lumpectomy plus radiation is the preferred treatment for most early-stage breast cancers. Still, mastectomy is commonly recommended for women diagnosed with more than one area of cancer in the same breast.
In recent years, advancements have been made in:
breast imaging techniques to more accurately detect additional tumors
therapies, including radiation therapy, to more effectively treat breast cancer
surgical techniques
In this study, the researchers wanted to see if these improvements could allow some women diagnosed with multiple areas of breast cancer in the same breast to have lumpectomy instead of mastectomy.
About the study
The study included 204 women ages 40 and older who were diagnosed with two to three areas of cancer in the same breast. All the women were interested in having lumpectomy rather than mastectomy.
About the breast cancers:
at least one of the areas of disease was invasive breast cancer; the additional area or areas could be DCIS
the largest a single tumor could be for this study was 5 centimeters (about 2 inches)
there had to be at least 2 centimeters of healthy tissue between the areas of cancer
areas of cancer could only be in two quadrants of the breast
4.4% had spread to the lymph nodes
26% were grade 1
47.1% were grade 2
25.5% were grade 3
83.5% were estrogen receptor-positive and HER2-negative
5% were triple-negative
11.5% were HER2-positive
All the women had a mammogram, an ultrasound, or both before surgery:
189 of the women also had a breast MRI before surgery
171 women had a mammogram or ultrasound followed by a breast MRI; MRI found a cancer that was not seen on the mammogram or ultrasound in 72 women (42.1%)
None of the women in the study had:
cancer in the other breast
breast implants
a known BRCA1 or BRCA2 mutation
chemotherapy or hormonal therapy before surgery
Among the women in the study:
average age was 61
86.3% were white
8.8% were Black
1.5% were Asian
0.5% were American Indian or Alaska Native
3.9% were Hispanic or Latino
96.6% were diagnosed with two areas of cancer in the same breast
3.4% were diagnosed with three areas of cancer in the same breast
All the women had lumpectomy to remove the areas of cancer. The study requirements called for all the women to have whole-breast radiation with a boost dose to each site of disease.
Overall, 193 women completed the required radiation treatment.
Tamoxifen or an aromatase inhibitor was recommended for women diagnosed with hormone receptor-positive tumors. Anti-HER2 medicine was recommended for women diagnosed with HER2-positive tumors who were receiving chemotherapy after surgery.
The women had follow-up visits every six months and had a mammogram of both breasts every year for five years after they completed radiation treatments.
The researchers checked to see how many women had local recurrence after treatment, which meant invasive breast cancer or DCIS was diagnosed in the same breast or in the chest wall.
After about 5.5 years of follow-up, six of the women had a local recurrence:
four women had cancer come back in the breast
one woman had cancer come back in the breast skin
one woman had cancer come back in the chest wall
The researchers estimated that the rate of local recurrence was 3.1%.
None of the women had a regional recurrence, which is when cancer comes back in the lymph nodes or collarbone area near the breast where the original cancer was diagnosed.
Four women had distant recurrence, which means the cancer came back in a part of the body away from the breast, such as the bones or liver. None of the women who had distant recurrence were diagnosed with local recurrence as well.
Six women developed breast cancer in the opposite breast, called contralateral breast cancer by doctors.
Three women were each diagnosed with another type of cancer:
one was diagnosed with lung cancer
one was diagnosed with gastric cancer
one was diagnosed with ovarian cancer
Eight women died; one death was related to breast cancer and seven were not.
The researchers’ analysis showed that the only factor linked to a higher risk of local recurrence was not having a breast MRI before surgery. Five-year local recurrence rates were:
22.6% in women who didn’t have an MRI before lumpectomy
1.7% in women who had an MRI before lumpectomy
The researchers concluded, “The Z11102 clinical trial demonstrates that breast-conserving surgery with adjuvant radiation that includes lumpectomy site boosts yields an acceptably low five-year [local recurrence] rate for [multiple ipsilateral breast cancer]. This evidence supports [breast-conserving therapy] as a reasonable surgical option for women with two to three ipsilateral foci, particularly among patients with disease evaluated with preoperative breast MRI.”
What this means for you
If you’ve been diagnosed with two or three areas of cancer in the same breast, this study offers information that can help you decide whether lumpectomy or mastectomy is the best option for you.
“This is a very important paper,” said Marisa Weiss, MD, chief medical officer and founder of Breastcancer.org. “With better breast imaging, like digital tomosynthesis mammography and MRIs, more women are being diagnosed with multifocal and multicentric disease. Rather than do an automatic mastectomy — traditional standard of care — many of these women may still be a candidate for breast preservation. And many of those women want breast preservation therapy, as long as it’s a safe and effective alternative. We needed this paper to establish a basis for this decision.
“Optimal selection of patients with multicentric disease is very important,” Dr. Weiss continued. “As the study points out, MRI is key to making sure that a woman only has two to three lesions with nothing else going on. I also recommend genetic testing before making this decision, since in the presence of a high risk inherited genetic mutation, such as BRCA1 or BRCA2, many women would lean toward mastectomy to both treat the diagnosed cancers and to reduce their higher risk of future cancers.”
Learn more about lumpectomy versus mastectomy.
— Last updated on June 5, 2023 at 1:25 PM