Local Breast Cancer Recurrence after Mastectomy and Breast-Conserving Surgery for Paget's Disease: A Meta-Analysis

Abstract

Background: Paget's disease (PD) of the breast is a rare presentation of breast malignancy. Mastectomy has been considered the standard of care, but several studies have shown that breast-conserving surgery (BCS) with radiotherapy is an alternative option. According to the literature, the total recurrence rate is as high as 20-40%. In an effort to enable a rational therapy decision, we compiled and analyzed the available data on PD. Methods: Pubmed, Web of Knowledge, and China Journal Net were searched for studies concerning treatment for PD between 1990 and 2013. A meta-analysis was performed to compare the effect of different treatments. Results: 7 studies with a total of 685 patients were included. The cumulative local recurrence rate was 7.6%, 5.6% among women undergoing mastectomy and 13.2% among those treated with BCS. Compared to the BCS group, mastectomy showed significant differences in terms of local recurrence (odds ratio = 0.38, 95% confidence interval 0.21-0.69; p = 0.001). Conclusion: Since not all currently available diagnostic and therapeutic options (magnetic resonance imaging, radiotherapy, tamoxifen) were systematically used in the studies included in this meta-analysis, it may be presumptuous to suggest that mastectomy is the right choice for all patients with PD in a modern interdisciplinary setting. Rather we can conclude that all efforts should be undertaken to assure local control since BCS is not equivalent to mastectomy in the treatment of PD.

Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10‐year (2006–2015) retrospective hospitalization summary report‐based study

“…BSC can be considered in patients with no presence of underlying neoplasm in the breast . There is an increasing trend in patients with Paget's disease to consider BCS; however, all efforts should be undertaken to ensure local control …”

Surgical treatment in Paget’s disease with invasive ductal carcinoma: an observational study based on SEER

“…However, with the development of imaging technology, breast conservation surgery (BCS) has been found to be a feasible surgical option with low risk for local recurrence in selected patients51011. In addition to BCS, sentinel lymph node biopsy (SLNB) may be effective in patients with PD; however, its role in PD treatment remains unclear.…”

Paget’s disease of the breast: study of cases series

“…A recent meta-analysis evaluating the recurrence rate among patients undergoing mastectomy and conservative surgery associated with radiotherapy observed that 13.2% of those who underwent conservative treatments and 5.2% of the ones who underwent mastectomy relapsed 11 . In the present study, no metastatic involvement was observed -neither axillary nor distant -, so the overall survival of patient with mean follow-up of 54 months was 100%.…”