Better survival rates seen with lumpectomy compared with mastectomy for early breast cancer

A new analysis has found that lumpectomy plus radiation for early breast cancer may provide patients with a better chance of survival than mastectomy.The results provide confidence in the efficacy of breast-conserving treatments even among patients with aggressive, early disease.

Lumpectomy combined with radiation is a good treatment choice for women with early breast cancer; however, over the past 10 years, a growing number of women have been choosing mastectomy even for very small cancers. In certain populations—such as women who are young and those living in urban areas with high socioeconomic status—this trend has been most pronounced due to the perception that outcomes may be better with mastectomy than with lumpectomy.

Shelley Hwang MD, MPH, of the Duke Cancer Institute, and her colleagues looked to see whether some populations of women do in fact have better outcomes after mastectomy compared with lumpectomy and radiation. The researchers obtained information regarding all women who were diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004 and who were treated with either mastectomy or lumpectomy plus radiation. The investigators followed 112,154 cases through 2009, and they looked for patterns among different age groups and across different breast cancer types.

In the first three years after surgery, women who underwent mastectomy had a higher risk of dying from heart disease and other diseases than women who underwent lumpectomy, possibly indicating that the latter group was generally healthier, according to Dr. Hwang. Over the entire study period, women were more likely to survive breast cancer after undergoing lumpectomy plus radiation than mastectomy. This was true among all age groups and cancer types, with the biggest benefit seen in women over 50 years of age with hormone-sensitive breast cancer. These women had a 14 percent decreased risk of dying from breast cancer during the study compared with their counterparts who underwent mastectomy.

“The findings in this study should reassure women that among all age groups and tumor types, lumpectomy continues to be an excellent choice for women with small early breast cancers,” said Dr. Hwang.

Reference: E. Shelley Hwang, Daphne Y. Lichtensztajn, Scarlett Lin Gomez, Barbara Fowble, and Christina A. Clarke. Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. CANCER; Published Online: January 28, 2013 (DOI: 10.1002/cncr.27795).