Lumpectomy vs. Mastectomy

This is a recent article from Medscape which contains important information that women diagnosed with Breast Cancer should be aware of.

Lumpectomy May Have Better Survival Than Mastectomy
No Data on Systemic Therapy
Nick Mulcahy Jan 28, 2013

The largest observational study of women with early breast cancer suggests that breast conserving therapy/BCT (lumpectomy and radiation therapy) is an effective alternative to mastectomy.
122,000 patient’s with stage I or II breast cancer from the California cancer registry were studied and the data suggested that the less invasive BCT (lumpectomy and radiation) may provide better survival.

Medscape Medical News asked two independent experts to comment on this study. One of them was Kandace McGuire M.D., a surgical oncologist at the Magee women’s Hospital the University of Pittsburgh Medical Center in Pennsylvania. Her comment was that “the results may reflect the unmeasured variables”. The unmeasured variables include improvements in systemic therapy which has been given credit for the further reduction in mortality from breast cancer seen in the last 20 years. The lack of data on systemic therapy was of concern to another expert.
A larger proportion of women in the mastectomy group were treated before 1999 when systemic therapy was used only in individuals that had positive lymph nodes.

After 1999, systemic therapy was used in women who are both node positive or node negative. As a result, the BCT group may have benefited from that extra treatment and the individuals who had mastectomy and no systemic therapy may have had worse outcomes because of the lack of systemic therapy.

Another consideration is that many times patients will choose mastectomy over BCT because there is a lack of access to radiation facilities either because of distance or inability to afford comprehensive care. There may have been individuals in the mastectomy group who had less access to these options and quality health care.

All seemed to agree that, “The greatest benefit was in postmenopausal women 50 years and older with estrogen-receptor-positive T1 tumors. At least equivalent outcomes were seen in all groups on multivariable analysis, with the 1 exception — women with tumors 4 to 5 cm. These women are probably not going to be eligible for lumpectomy anyway because their tumors are too big, Dr. Hwang explained”.

For more details ask your Health Care Provider and read:
Cancer. Published online January 28, 2013. Abstract