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Surgery for Lung Mets

Posted 10/8/2013

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  This study from Germany, published in The Annals of Thoracic Surgery, is a big deal. As you may know, surgery is rarely part of the treatment for metastatic breast cancer. The assumption/reality is that, once mets are seen somewhere else in the body (meaning that the cancer has spread from the breast and axillary lymph nodes), it is many places--whether or not there are enough cells to be seen on a scan or MRI. Therefore, the practice has been that surgery does not increase survival and adds unnecessary risks and discomfort to a woman's life.

  That is still the general view and standard of practice. A single study is not going to change that, but it likely will encourage doctors to think carefully about individual situations and practice. Through the years, I have known women with metastatic breast cancer who have had surgery for a single liver met or orthopedic because of bone mets. I can't recall hearing of anyone who had lung mets removed, but I susect this will now become part of the conversation.

  I recognize that most readers of this blog, blessedly, do not have metastatic/advanced breast cancer. My intent is certainly not to frighten anyone, but I don't think it helps us to keep our heads buried in the sand, and generally being informed is a good thing. Here is the start of a summary from Living Beyond Breast Cancer and then a link to read more:

Study Suggests Surgery for Women With Lung Metastases May Improve Survival
A German study indicates that surgical removal of lung metastases may help women with advanced breast cancer live longer

A German study published in The Annals of Thoracic Surgery suggests that surgical removal of breast cancer metastases that affect a small part of the lungs may help women live longer.

In their study, the researchers also examined factors such as size, subtype and the number of metastases, which may influence overall survival, the time a person lives from the beginning of a study until death from any cause.

Background and Reason for the Analysis

Experts estimate that nearly 30 percent of women with early-stage disease will progress to metastatic breast cancer, an advanced stage in which the cancer cells spread to distant parts of the body. The average life expectancy of a woman with metastatic disease can vary widely depending on a large number of tumor and treatment factors.

Surgery is rarely performed on women with metastatic breast cancer, including those with lung metastases. The reason for this is because the presence of metastases in one part of the body is often considered a sign of systemic disease, meaning the cancer could have spread to parts of the body other than the lungs. Surgery is also only effective if the cancer affects a small part of the lungs.

The researchers’ goals were to learn if removing metastases from the lungs by surgery offers a survival benefit to women with metastatic breast cancer affecting small parts of the lungs. They also wanted to find out what other factors might influence survival rates.


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