A study published in the journal Cancer suggests women with early-stage breast cancer have at least an equal, if not greater, chance of survival with a lumpectomy followed by radiation therapy rather than a mastectomy alone.
This trend in survival was noted among more than 112,000 women studied after adjusting for race, socioeconomic status, age at diagnosis, number of lymph nodes testing positive for cancer, and tumor sizes and grades.
Background and Reason for the Study
Women with some early-stage breast cancers may choose between mastectomy and lumpectomy followed by radiation. Lumpectomy is surgically removing the cancer with a small margin of healthy breast tissue. Mastectomy is surgically removing the entire breast.
Despite a trend in more women having mastectomies, previous randomized controlled studies showed women have equal outcomes with either treatment choice. The current researchers sought to find out whether these results held up in an environment more like that of the general public, where a diverse group of women received the treatments in a way not specific to any one health institution’s guidelines.
The data included 112,154 cases of women living in California who were newly diagnosed with stage I and II breast cancer from January 1990 to December 2004. All were treated with either lumpectomy and radiation therapy or mastectomy without radiation therapy, and were followed through December 2009. Researchers also considered the hormone receptor status of the tumors.
Four groups of women were compared and classified by age at time of diagnosis and by tumor type, including those
- 50 or older whose tumors tested HR negative.
- 49 or under whose tumors tested HR positive.
- 50 or older whose tumors tested HR positive.
- 49 or under whose tumors tested HR negative.
Women with discrepancies in tumor hormone status of any kind were excluded. HER2 status was not indicated in the study since testing for that status was not available before 2006.
The researchers studied associations between type of treatment (lumpectomy and radiation therapy vs. mastectomy), overall survival (the time from diagnosis until death from any cause) and disease-specific survival (the time from diagnosis until death from breast cancer).
Among the participants, 61,771 received lumpectomy and radiation while 50,383 had mastectomy. Median follow-up time was about 9 years. A total of 31,416 women died, 39 percent because of breast cancer. The 5-year overall survival in the group was 89.3 percent.
All four groups showed improved overall survival with lumpectomy and radiation compared with mastectomy. The group that benefited most were women ages 50 and older at diagnosis with HR positive breast cancer. This group had a 13 percent lower risk of dying of breast cancer throughout the study period, and a 19 percent lower risk of dying from any cause.
This was not a randomized controlled trial. The characteristics of the cancers that investigators examined in both groups were not the same. Women who had lumpectomy followed by radiation therapy had smaller tumor sizes and breast cancers at earlier stages than those who underwent mastectomy.
A possible reason for greater survival rates with lumpectomy is that the women who received lumpectomies did not have additional health issues such as heart-disease or respiratory problems.
What This Means for You
The results of this study suggest that in many cases lumpectomy with radiation therapy is an effective option to mastectomy if you have stages I or II breast cancer. This finding may help you feel confident choosing lumpectomy with radiation therapy over mastectomy, if your doctor gives you both options.
Some women may not be able to, or choose not to, undergo a lumpectomy because of the nature of the tumor in their breast. Talk with your doctor to learn more about treatment options that may work best for you.
For a list of questions to ask your doctor about lumpectomy and radiation versus mastectomy, download our Guide to Understanding to Treatment Decisions.
Hwang, ES, Lichtensztajn, DY, Gomez, SL, Fowble, B, and Clarke, CA. Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer. 2013;119(6):1-10.