For women diagnosed with breast cancer, is it more beneficial to undergo mastectomy or breast conserving therapy (BCT)? A new study reports that, for young women especially, BCT was associated with an increased risk in disease recurrence, as compared to mastectomy.
Breast cancer is the most common cancer in women worldwide. In 2012, breast cancer represented 12 percent of all new cancer cases in women, affecting nearly 1.7 million females. Among the deluge of difficult decisions brought on by the breast cancer diagnosis, young women often have to choose between breast conserving therapy (BCT) or mastectomy. Also known as segmental mastectomy, BCT involves surgeons attempting to remove the diseased part of the breast while preserving the breast structure. By contrast, the more radical approach of mastectomy involves the complete removal of the breast.
The risk of recurrence between the two types of therapies has yet been examined extensively until now. At the European Society for Radiotherapy and Oncology (ESTRO) conference this past week, researchers reported that women under 45 who had BCT had a 13 percent increase in disease recurrence over a 20-year period. This is compared to women who underwent mastectomy without radiation. Importantly, this increased risk was not observed for women who were over 45 years of age.
The results were obtained by following a cohort of 1076 Danish women for 20 years. The women were diagnosed with low-risk breast cancer, and 364 of them received BCT only, while 712 received mastectomy only.
Of the women who received BCT, the proportion of local recurrences was 18 percent versus the 6.7 percent with mastectomy. Interestingly, the time of disease recurrence happened in earlier for women who had mastectomies (within 5-10 years). By contrast, women who received BCT showed disease recurrence throughout the 20-year period. Recurrence of the disease also increased the risk of metastasis and patients who received BCT had a two-third higher risk of death compared to mastectomy patients.
Of course this does not mean that mastectomy is the only effective treatment for breast cancer. More appropriately, the study backs up using BCT in women over 45 years of age. "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,” said Tinne Laurberg, physician at the Aarhus University Hospital, and study author.
But for women younger than 45, the study highlights the need for careful evaluation of treatment plans that take into account BCT risk factors. This study was the first of its kind to include such a big population sample and a long follow-up period. Thus it enhances the reliability of the observed data trend.
Additional source: Science Daily