Survival is Better After Breast Conserving Therapy than Mastectomy for Early Stage Breast Cancer: A Registry-Based Follow-up Study of Norwegian Women Primary Operated Between 1998 and 2008

Abstract

BackgroundBreast-conserving therapy (BCT) and mastectomy (MTX) has been considered to have a similar long-time survival. However, better survival in women undergoing BCT compared with MTX is found in two recent register studies from the United States. The purpose of this study was to compare survival after BCT and MTX for women with early-stage breast cancer in Norway.MethodsWomen with invasive, early-stage breast cancer (1998–2008) where BCT and MTX were considered as equally beneficial treatments were included for a total of 13,015 women. Surgery was divided in two main cohorts (primary BCT, primary MTX) and five subcohorts. Analyses were stratified into T1N0M0, T2N0M0, T1N1M0, T2N1M0, and age groups (<50, 50–69, ≥70). Overall survival and breast cancer-specific survival (BCSS) were calculated in life tables, hazard ratios by Cox regression, and sensitivity analyses.ResultsFive-year BCSS for women who underwent primary BCT or primary MTX was 97 and 88 %, respectively. Women who underwent primary MTX had a hazard ratio of 1.64 (95 % confidence interval 1.43–1.88) for breast cancer death compared with women who underwent primary BCT after adjusting for the year of diagnosis, age at diagnosis, stage, histology, and grade.ConclusionsSurvival was better or equal after breast-conserving therapy than mastectomy in all early stages, surgical subcohorts, and age groups. This advantage could not only be attributed to differences in tumor biology.

Breast conserving therapy and mastectomy revisited: Breast cancer‐specific survival and the influence of prognostic factors in 129,692 patients

“…Our results further support the hypothesis that BCT might be the preferred choice for breast cancer patients when both BCT and mastectomy are suitable treatment options . A previous observational study that also investigated survival outcomes following both types of surgery hypothesized that the prognostic advantage of BCT over mastectomy may be related to the effects of RT as a component of BCT while early stage mastectomy patients in general receive no RT5.…”

“…Large randomized controlled trials (RCTs) in the 1980s have shown equal survival for breast‐conserving therapy (breast‐conserving surgery plus radiation therapy, BCT) and mastectomy in early stage breast cancer . Over recent years, however, multiple observational studies have challenged this equivalence, showing superior survival for patients treated with BCT compared to those treated with mastectomy . The use of population‐based observational studies in studying treatment effects can be of additional value on outcomes obtained through RCTs.…”

Predictors of Disruptions in Breast Cancer Care for Individuals with Schizophrenia

“…Compared with patients who have breast-conserving therapy, patients with early-stage cancer who have mastectomies have longer delays to adjuvant chemotherapy and radiation and lower rates of BCSS [36,37]. In contrast, rates of discontinuation of endocrine therapy were similar to national cohorts; 50% of patients nationally, and 48% in our sample, with schizophrenia with estrogen receptor/progesterone receptor-positive breast cancer had discontinued endocrine therapy at 5 years [38,39].…”

Effect of intraoperative radiotherapy for early breast cancer on 10‐year recurrence rates and overall survival

“…Previous authors indicated long‐term overall survival rates between 77% and 94% in patients underwent BCS followed by standard radiotherapy with or without boost . Despite the high ipsilateral breast cancer recurrence found in our study, the 10‐year overall survival of 82.8% was in accordance with previous literature.…”