Survival after lumpectomy and mastectomy for early stage invasive breast cancer: The effect of age and hormone receptor status

Department of Surgery, Duke University Comprehensive Cancer Center, Durham, North Carolina. .
Cancer (Impact Factor: 4.89). 09/2013; 119(7). DOI: 10.1002/cncr.27795
Source: PubMed


Randomized clinical trials (RCT) have demonstrated equivalent survival for breast-conserving therapy with radiation (BCT) and mastectomy for early-stage breast cancer. A large, population-based series of women who underwent BCT or mastectomy was studied to observe whether outcomes of RCT were achieved in the general population, and whether survival differed by surgery type when stratified by age and hormone receptor (HR) status.

Information was obtained regarding all women diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004, who were treated with either BCT or mastectomy and followed for vital status through December 2009. Cox proportional hazards modeling was used to compare overall survival (OS) and disease-specific survival (DSS) between BCT and mastectomy groups. Analyses were stratified by age group (< 50 years and ≥ 50 years) and tumor HR status.

A total of 112,154 women fulfilled eligibility criteria. Women undergoing BCT had improved OS and DSS compared with women with mastectomy (adjusted hazard ratio for OS entire cohort = 0.81, 95% confidence interval [CI] = 0.80-0.83). The DSS benefit with BCT compared with mastectomy was greater among women age ≥ 50 with HR-positive disease (hazard ratio = 0.86, 95% CI = 0.82-0.91) than among women age < 50 with HR-negative disease (hazard ratio = 0.88, 95% CI = 0.79-0.98); however, this trend was seen among all subgroups analyzed.

Among patients with early stage breast cancer, BCT was associated with improved DSS. These data provide confidence that BCT remains an effective alternative to mastectomy for early stage disease regardless of age or HR status.

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Available from: Christina A Clarke, Mar 06, 2015
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    • "Screening mammography programmes may not be feasible in these settings and alternative strategies for this group may include public awareness programmes, breast self examination and clinical breast examination (Anderson et al., 2011). Evidence shows that women who seek treatment in the early stages of breast cancer have better chances of survival (Hwang et al., 2013;American Cancer Society, 2014). For detection at an early stage, women must be aware of the disease symptoms and of simple prevention strategies such as breast self-examination. "
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    • "Thus, lobular carcinoma patients who received breast-conserving surgery seemed to have better prognosis than those who were treated with mastectomy. Several recent populationbased studies that included lobular breast cancer cases also identified an OS benefit of breast-conserving surgery vs. mastectomy, however, the percentages of lobular carcinomas in these studies were either very small (≤10%) or unknown, and no subset analysis was performed to assess the impact of surgery type on survival in lobular cancers272829. Further randomized controlled studies addressing this issue are warranted to confirm our findings. "
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    • "The smallest benefit was seen among women who were under age of 50 diagnosed with HR-positive tumors. Kaplan-Meier survival estimation showed significantly greater overall and breast cancer-specific survival favoring BCS over mastectomy[3]. In another prospective, randomized study of 749 elderly patients with tumor less than 25 mm and pN0, ER+, G1-2, Ki-67<20 %, concluded that whole breast irradiation after BCS can be omitted in selected patient. "
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