Women with early-stage breast cancer treated with lumpectomy followed by radiation may live longer than those receiving mastectomy alone or with radiation, researchers found.
Their study, published in the journal JAMA Surgery, compared the risk of dying from breast cancer over 10 years.
In 1990, the National Institutes of Health recommended lumpectomy instead of mastectomy for women with early-stage breast cancer. The recommendation was based on data from several large, randomized, controlled trials showing no difference in survival rates after 20 years in women treated with either lumpectomy followed by radiation or mastectomy.
Past trial results are now 40 years old, and treatments, detection and knowledge of breast tumors have since advanced. With this in mind, researchers from the Universities of Michigan and Utah wanted to compare again the breast cancer-specific survival rates of women who had either of the treatments.
Authors of the current study assessed information on more than 130,000 women between the ages of 18 and 80 years, treated for early-stage breast cancer between 1998 and 2008. The women studied lived in regions spanning most of the U.S. Researchers considered them to have early-stage disease if they had a tumor less than 4 centimeters, with 3 or fewer lymph nodes positive for cancer.
Of women meeting those criteria:
- 70 percent had lumpectomy with radiation
- 27 percent had mastectomy
- 3 percent had mastectomy with radiation
Factors accounted for included:
- year of diagnosis
- race/ethnicity, coded as white, black, other and unknown
- number of positive lymph nodes: 0 or 1–3
- tumor size: ≤2 cm vs >2 to 4 cm
The database the researchers used collects information on all cancerous tumors in 18 cancer registries across the country, capturing 28 percent of the population.
Researchers calculated the percentage of women alive 5 years and 10 years after treatment.
At 5 years, breast cancer-specific survival rates were:
- 97 percent for lumpectomy plus radiation
- 94 percent for mastectomy alone
- 90 percent for mastectomy plus radiation
At 10 years, the rates were:
- 94 percent for lumpectomy plus radiation
- 90 percent for mastectomy alone
- 83 percent for mastectomy plus radiation
A higher percentage of patients who had mastectomy alone or with radiation had larger tumor sizes and positive lymph nodes compared with those who had lumpectomy with radiation. Yet, even when controlling for positive lymph nodes and tumor size, those who had lumpectomy plus radiation continued to show improved survival. Further study is needed to confirm the survival benefit of lumpectomy plus radiation.
Race affected survival rates regardless of which treatment women had. African-Americans had a greater risk of breast cancer death than whites, despite adjusting results for other demographic differences and kinds of tumor. Women with larger tumors (>2 to 4 cm) had a greater risk of breast cancer-specific death than those with smaller tumors.
Researchers did not look into why women receiving lumpectomy followed by radiation have a greater chance of living longer. They say it’s possible that the kind of adjuvant therapy they were treated with explains the difference. Adjuvant therapy is treatment given after surgery and may include chemotherapy, radiation, or endocrine therapy. The size and qualities of the tumors, as well as lifestyle factors, may also have played a role.
What This Means for You
The findings of this study support those of past studies showing lumpectomy plus radiation is effective at treating early-stage disease. Removing the whole affected breast does not give one a survival advantage. If you are among the 60 percent of women with early-stage breast cancer choosing lumpectomy followed by radiation, this information may help you feel more confident in your choice.
Because breast cancer care decisions are highly personal, it’s important to discuss surgery options with your physician. Together, you will identify the treatment best for you.
To learn more, read our Guide to Understanding Treatment Decisions.