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Better Survival with Smaller Surgery

Posted 7/20/2016

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  In the world of breast cancer, this is a really important study. As you may know, the rate of newly diagnosed women opting for mastectomies rather than wide excision/lumpectomies has really increased. Even more surprising, the rate of women opting for bilateral mastectomies. Approximately 20% of all newly diagnosed women make this choice as opposed to 5% ten years ago. This is stunning. In spite of a great deal of medical data indicating that most of these surgeries are "overkill", women continue to too often believe this is a safer choice. There is, of course, the celebrity influence, too. How many times have we all read about Angelina Jolie's cancer surgery? And remember that her surgery was to prevent cancer since she carries a BRCA gene mutation; she, blessedly, has not had breast cancer.

  When we are first diagnosed with cancer, any kind of cancer, most of us are in a state of shock and panic and completely focused on trying to stay alive. If we think that removing both breasts will increase our chances, of course that looks smart. The fact is that it is rarely true. Women who carry a BRCA gene mutation are advised to have bilateral mastectomies, often prophylactic, (a la Ms. Jolie) and there are a few other uncommon medical situation when this would be the best medical advice.

  For the overwhelming majority of breast cancers, however, the danger is the known cancer. Breast cancer does not spread from one breast to the other. The treatment is to remove the tumor and usually follow surgery with systemic treatment, chemotherapy and/or hormonal therapy. Radiation is part of the package with a wide excision and sometimes with a mastectomy.

  This is an important report from ASCO about a newly released study from Lancet Oncology. More than 37,000 women were reviewed, and the evidence was that wide excision plus radiation greatly improved the odds of survival over mastectomy. Here is the start of the story and a link:

Better 10-Year Survival Reported With Breast-Conserving
Surgery and Radiotherapy vs Mastectomy in Early Breast

By Matthew Stenger

In a Dutch population-based study reported in The Lancet Oncology
(, van
Maaren et al found that breast-conserving surgery plus radiotherapy was associated with
improved 10-year survival vs mastectomy in women with early breast cancer.
Study Details
The study included data from 37,207 women from the Netherlands Cancer Registry
( diagnosed with primary invasive stage T1–
2, N0–1, M0 breast cancer between January 2000 and December 2004 who received either
breast-conserving surgery plus radiotherapy (n = 21,734; 58%) or mastectomy (n = 15,473;
42%) irrespective of axillary staging or dissection or use of adjuvant systemic therapy. To
adjust for confounders, multivariate analyses included factors that significantly differed
between treatment groups in univariate analysis.

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