Breast Surgery in Advanced Disease

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Breast Surgery in Advanced Disease

Posted 12/1/2011

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Especially in my weekly group for women with advanced breast cancer, we often discuss this issue. Does it make sense/can it be helpful for women with metastatic breast cancer at the time of diagnosis to have breast surgery? Generally, the answer has been "no". The old saying about the horse being already out of the barn is used to explain the decision. In other words, the thinking is that the cancer has already spread, so there is no reason to subject a woman to surgery in an attempt to contain it to the breast. Through the years, I have known several women who opted for surgery at some point during their experience and others who, have careful consultation and consideration, decided not to pursue this option.

This is an article from The Breast about this issue. I give you the abstract and a link:

Does primary tumor resection improve outcomes for patients with inc urable advanced breast cancer?

Susumu Shibasaki, Hiromi Jotoku, Kenichi Watanabe, Masato Takahashi

* Department of Breast Surgery, Hokkaido Cancer Center, National Hospital Organization, Sapporo, Japan.

Background: Metastatic breast cancer (MBC) is considered incurable, and surgery has only limited benef!t in the treatment of this disease. However, recent reports have indicated that primary tumor resection may improve patient outcomes. We retrospectively analyzed the surgical bene!ts and prognostic factors for patients with MBC who were treated at our center.

Methods: Ninety-two women, who had tumors of greater than 5 cm and distant metastasis at diagnosis, were included in this study. The effect of surgical treatment on survival was evaluated. Patient demographics and tumor characteristics were also investigated.
Results: Thirty-six patients had surgery for resection of primary tumors. There were no substantive differences between individuals, or between tumor characteristics, for patients who underwent surgery versus patients who did not. The median survival time for surgically treated patients was 25.0 months versus 24.8 months for patients who did not undergo surgical resection (P ¼ 0.352). Only three patients relapsed within three months of surgery. For the remaining majority of patients, primary tumor resection gave some relief from the often severe symptoms that come from harboring a large tumor for an extended time. In univariate and subsequent multivariate analyses of predictive indicators, a diagnosis of triple-negative breast cancer and/or metastasis to more than three sites was signi!cantly associated with a severe prognosis.
Conclusion: Primary tumor resection failed to prolong overall survival times in patients with incurable advanced breast cancer that was greater than 5 cm. However, surgery did improve the quality of life in patients who were expected to have a relatively long prognosis.