Decreased Survival With Mastectomy Vis-à-Vis Breast-Conserving Surgery in Stage II and III Breast Cancers: A Comparative Treatment Effectiveness Study

Abstract

PurposeThe primary purpose of hospital-based cancer registries is assessing patient care. Clinical stage–based survival and treatment-based survival are some of the key parameters for such assessment. Because of the challenges in obtaining follow-up parameters, a separate study on patterns of care and survival was undertaken by the Indian National Cancer Registry Program. The results for cancer of the female breast are presented here.Patients and MethodsData abstracted in a standardized patient information form were transmitted online to a central repository. Treatment patterns were assessed for 9,903 patients diagnosed between January 1, 2006, and December 31, 2008, from 13 institutions. Survival analysis was restricted to 7,609 patients from nine institutions wherein follow-up details (as of December 31, 2012) were available for at least 60% of patients.ResultsThe overall 5-year survival rates with breast-conserving surgery (BCS) and mastectomy (MS) were 94.0% and 85.8%, respectively, for stage II disease (adjusted hazard ratio, 2.40; 95% CI, 1.8 to 3.2) and 87.1% and 69.0%, respectively, for stage III disease (hazard ratio, 2.82; 95% CI, 2.2 to 3.7). Patients who had MS did better with systemic therapy (chemotherapy and/or hormone therapy), whereas patients with BCS required just local radiation therapy to achieve best survival.ConclusionThis observational study in the natural setting of care of patients with cancer in India showed significantly decreased survival with MS when compared with BCS. The reasons for lower survival with MS and the biologic or scientific rationale of the necessity of systemic therapy to achieve optimal survival in patients undergoing MS but not in those with BCS need further investigation.

Ten-year survival outcome of breast cancer patients in India

“…As per the ICMR data based on cumulative analysis of data from 13 institutions across the country, the cumulative 5-year survival of a cohort of 7609 patients was 73.8%. [ 10 ] Subsequently, there have been a few more studies which have looked at 5-year OS,[ 9 ] which showed better survival, but no Indian data looked at 10-year survival outcome and more. Globally, also there have been only a small number of studies looking at more than 10-year survival outcome from a single hospital.…”

“…Available data from India are mainly on 5-year survival figures from some of the major cancer treatment centers. [ 8 9 10 ] Many patients are lost to follow-up after 5 years of primary treatment at oncology centers, even after the importance of follow-up visit is explained. [ 11 ]…”

Saving the Breast Saves the Lives of Breast Cancer Patients

“…In all of these trials, not only was there no inferiority for BCS versus mastectomy regarding local recurrences, distant metastases, and overall survival but also many studies showed benefits for breast conservation therapy (BCT) over mastectomy. Besides, some trials demonstrated a slightly more favorable outcome in patients with positive nodes treated with BCS; however, the differences were not statistically significant [14][15][16][17][18][19][20].…”

Extreme Oncoplastic Surgery for Multifocal/Multicentric and Locally Advanced Breast Cancer

“…Multiple prospective randomized trials [4], some with a follow-up of 20 years, have established equivalent survival rates between mastectomy and breast conservation surgery (BCS) with negative margins. Recent studies from various countries including India indicate that women treated with BCT have a significant survival advantage when compared to mastectomy [5–7].…”