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

Wheatley, Duncan

doi:10.1016/j.clon.2021.03.014

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…As pointed out by Dodwell et al, women with screen-detected breast cancer are more likely to undergo BCT and mammographic screening confers a survival advantage compared to symptomatic presentation [69]. In our study, in which two-thirds of patients were aged between 50 and 70 years (n = 880, 64.7%) and a similar proportion had stage I disease (n = 891, 65.5%), individual data regarding screening status were missing.…”

Section: Discussionmentioning

confidence: 64%

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

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.

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Section: Discussionmentioning

confidence: 64%

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

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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“…Unlike the present analysis, none included information on both co-morbidity and frailty, and only one used a landmark approach to minimize immortal time bias. With these methodological limitations, it is not reasonable to conclude survival superiority of BCS with radiotherapy over mastectomy based on observational data alone 40 . The current analysis highlights the value of presenting standardized survival estimates, alongside traditional HRs, as a more informative method to explore outcomes and aid clinical interpretation 32 .…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes after breast cancer surgery among older women with early invasive breast cancer in England: population-based cohort study

Miller,

Gannon,

Medina

et al. 2024

BJS Open

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Background This study assessed the influence of age, co-morbidity and frailty on 5-year survival outcomes after breast conservation surgery (BCS) with radiotherapy (RT) versus mastectomy (with or without RT) in women with early invasive breast cancer. Methods Women aged over 50 years with early invasive breast cancer diagnosed in England (2014–2019) who had breast surgery were identified from Cancer Registry data. Survival estimates were calculated from a flexible parametric survival model. A competing risk approach was used for breast cancer–specific survival (BCSS). Standardized survival probabilities and cumulative incidence functions for breast cancer death were calculated for each treatment by age. Results Among 101 654 women, 72.2% received BCS + RT and 27.8% received mastectomy. Age, co-morbidity and frailty were associated with overall survival (OS), but only age and co-morbidity were associated with BCSS. Survival probabilities for OS were greater for BCS + RT (90.3%) versus mastectomy (87.0%), and the difference between treatments varied by age (50 years: 1.9% versus 80 years: 6.5%). Cumulative incidence functions for breast cancer death were higher after mastectomy (5.1%) versus BCS + RT (3.9%), but there was little change in the difference by age (50 years: 0.9% versus 80 years: 1.2%). The results highlight the change in baseline mortality risk by age for OS compared to the stable baseline for BCSS. Conclusion For OS, the difference in survival probabilities for BCS + RT and mastectomy increased slightly with age. The difference in cumulative incidence functions for breast cancer death by surgery type was small regardless of age. Evidence on real-world survival outcomes among older populations with breast cancer is informative for treatment decision-making.

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Counterpoint: 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

Cited by 2 publications

References 20 publications

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

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

Survival outcomes after breast cancer surgery among older women with early invasive breast cancer in England: population-based cohort study

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