Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer?

Abstract

Clinical Oncology j o ur n a l h o m e p a ge : w w w . c l i n i c a l on c o l o gy o n l i ne . n e t

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

“…Consequently, breast cancer mortality rates have declined in recent decades even in patients with a low risk of recurrence at baseline [53]. However, the contributions of a particular type of local treatment and new developments related to both surgical techniques and modern radiation therapy are frequently overlooked [54]. It is well known that prevention of locoregional recurrence reduces the risk of breast-cancer-specific death and is related to improvements in OS [55,56].…”

“…It is well known that prevention of locoregional recurrence reduces the risk of breast-cancer-specific death and is related to improvements in OS [55,56]. Many possible reasons for the better outcomes observed for patients with breast cancer undergoing lumpectomy combined with postoperative radiotherapy compared with mastectomy have been already elucidated [46,54,57,58]. Surgery does provide superior local control within resected tissue; however, with tangential radiotherapy techniques, the treated volume is larger (as compared to simple mastectomy) and typically includes unoperated breast tissue in its entirety, part of the muscle, regional lymphatics, draining lymphatics towards the axillary region, subcutaneous lymphatic plexus, and skin [46].…”

Counterpoint: Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer?

“…In the context of the choice between BCS and mastectomy for early breast cancer, evidence from long-term follow-up of 4891 patients treated in randomised trials shows equivalent mortality and recurrence outcomes [1]. Much non-randomised evidence from large observational cohorts, in total comprising over a million patients, shows that BCS þ WBRT is associated with improved mortality [11]. How can these conflicting conclusions be explained?…”

“…The associations between BCS þ WBRT and improved outcomes are less apparent in subgroups at higher risk of recurrence, e.g. higher TN stage or triple-negative phenotype and patients within these subgroups are much less likely to have been diagnosed through screening [11].…”

“…A recent development that may also influence patterns of surgical practice in the opposite direction and the advice given to women diagnosed with early breast cancer, is the publication of a number of observational studies that have reported that BCS þ WBRT is associated with improved survival outcomes when compared with mastectomy. The accompanying editorial [11] describes many of these studies and articulates the view that, given the significant association between the use of BCS þ WBRT and improved outcomes, the results from these publications should have major implications for surgical care and that patients should be informed of these findings to promote shared decision-making.…”