Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009

Abstract

BackgroundRecent registry studies on early-stage breast cancer have shown better survival rates when women underwent breast-conserving therapy (BCT) compared with mastectomy (MTX). The aim of this study is to investigate women participating in screening, in all four stages of early breast cancer (T1N0M0, T2N0M0, T1N1M0, and T2N1M0), as to whether there is a survival benefit when women undergo BCT compared to MTX.MethodA cohort of 6387 women aged 50–69, with primary-operated breast cancer from January 1998 to December 2009, participating in screening and followed-up until the end of 2010. Life tables were calculated by stages (pT1N0M0, pT2N0M0, pT1N1M0, and pT2N1M0), surgery groups (BCT and MTX), and screening detection (first screening, later screening, or interval cancer). Cox regression was used to calculate hazard ratios (HR) between BCT and MTX in crude and adjusted analyses.ResultsIn stage T1N1M0, women who underwent MTX had an HR of 2.91 (95% CI 1.30–6.48) for breast cancer death compared to women who underwent BCT, after adjusting for screening detection, years of diagnosis, age at diagnosis, histology, grade, and hormone receptor status. For all other TNM categories of early breast cancer, there was no difference in survival.10-year breast cancer-specific survival (BCSS) in T1N0M0 was 98% for women undergoing BCT and 96% for women undergoing MTX. 10-year BCSS in T1N1M0 was 97% for women undergoing BCT and 89% for women undergoing MTX.ConclusionsFor women participating in screening, there is a benefit of BCT over MTX in stage T1N1M0. No such effects were observed in the other early stages of breast cancer.

Breast-conserving surgery with or without irradiation in women with invasive ductal carcinoma of the breast receiving preoperative systemic therapy: A cohort study

“…The detailed outcomes of OS, LRR, or distant metastasis (DM) are still unclear in patients with breast cancer receiving PST and BCS with or without WBRT. Thus far, observations in patients with breast cancer receiving PST and BCS followed by WBRT are consistent with those of earlier studies that included patients who did not receive PST but received BCS followed by WBRT [ [1] , [2] , [3] , [15] , [16] , [17] , [18] ]. The necessity of WBRT in patients with breast cancer receiving PST and BCS has never been investigated.…”

“…No study, however, has estimated the requirement of WBRT for patients with invasive ductal carcinoma of the breast (breast IDC) receiving PST and BCS. All evidence of BCS followed by WBRT is based on observations in patients with breast cancer not receiving PST [ [1] , [2] , [3] , [15] , [16] , [17] , [18] ]. The detailed outcomes of OS, LRR, or distant metastasis (DM) are still unclear in patients with breast cancer receiving PST and BCS with or without WBRT.…”

Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study

“…TM may provide women with a safe alternative to mastectomy or offer improved cosmetic and quality‐of‐life outcomes compared with standard BCS, but high‐quality evidence to support the safety and effectiveness of the technique is lacking. RCTs comparing TM with other techniques are largely inappropriate due to patient and surgeon preference, as well as mounting evidence suggesting long‐term survival benefits for patients undergoing BCS and radiotherapy compared with mastectomy. This large prospective multicentre cohort study assessed current practice and short‐term outcomes of the technique and provided ‘real world’ data from 50 centres regarding complications, rates and management of incomplete excision, and impact of TM procedures on the delivery of adjuvant therapy.…”

Clinical outcomes and surgical preferences for breast-conserving surgery and mastectomy: a propensity score-matched analysis

“…Previous randomized controlled trials conducted to evaluate the outcomes of BCS compared to mastectomy have found no differences in the disease-free survival and overall survival of patients [2][3][4][5][6][7]. In fact, observational real-world studies using data obtained from national cancer registries have determined that better cancer-specific survival and overall survival outcomes were attained in patients who underwent BCS compared to mastectomy [2,[11][12][13][14]. However, in Thailand, while there has been a rise in the incidence of breast cancer, preference for BCS remains very low.…”