Survival after lumpectomy and mastectomy for early stage invasive breast cancer

Abstract

Background Randomized clinical trials (RCT) have demonstrated equivalent survival for breast conserving therapy with radiation (BCT) and mastectomy for early stage breast cancer. We studied a large, population-based series of women who underwent BCT or M to observe whether outcomes of RCT were achieved in the general population, and whether survival differed by surgery type when stratified by age and hormone receptor (HR) status. Methods We obtained information regarding all women diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004, treated with either BCT or mastectomy and followed for vital status through December 2009. We used Cox proportional hazards modeling to compare overall survival (OS) and disease-specific survival (DSS) between BCT and mastectomy groups. Analyses were stratified by age group (<50 years and ≥50 years) and tumor hormone receptor (HR) status. Results 112,154 women fulfilled eligibility criteria. Women undergoing BCT had improved OS and DSS when compared to women with mastectomy (adjusted HR for OS entire cohort 0.81, 95% CI 0.80 – 0.83). The DSS benefit with BCT compared to mastectomy was greater among women age≥50 with HR-positive disease (HR 0.86, 95% CI 0.82–0.91) than among women age<50 with HR-negative disease (HR 0.88, 95% CI 0.79–0.98); however, this trend was seen among all subgroups analyzed. Conclusion Among patients with early stage breast cancer, BCT was associated with improved DSS. These data provide confidence that BCT remains an effective alternative to mastectomy for early stage disease regardless of age or HR status.

Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011

“…Previous SEER studies have compared 2 treatments at a time: some reported a survival advantage with bilateral vs unilateral mastectomy 21,22 and others reported improved survival after breast-conserving surgery with radiation compared with unilateral mastectomy. 23,24 By comparing all 3 surgical options for a patient with early-stage breast cancer, we found no mortality benefit associated with bilateral mastectomy compared with breast-conserving surgery, and higher mortality associated uniquely with unilateral mastectomy.…”

Tumor biology in older breast cancer patients – What is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients

“…Some authors found lower mastectomy rates in oBCP [2,5] whilst others found it increased [1,20,22,35] including larger epidemiological studies [36,37]. An informed consent has been shown to increase the compliance and patient satisfaction [38].…”

Sentinel-Node-Driven Personalized Radiation Techniques Ranging from Partial Breast Irradiation to Regional Nodal Radiation after Breast-Conserving Surgery

“…Breast-conserving therapy consisting of BCS with radiotherapy has become the standard of care for early-stage breast cancer because of equivalent local control and survival for both BCT and mastectomy. Moreover, according to a recent report, BCT was associated with improvement in overall survival and diseasespecific survival regardless of age or hormone receptor status [33]. Although EBCTCG data demonstrated that omission of radiotherapy was one of the most relevant factors associated with local recurrence and the relationship between effects on local control and breast cancer mortality showed that 1 death from breast cancer could be avoided for every 4 local recurrences prevented [3,4], 20% of patients who underwent BCS in Japan did not receive WBI [34] because they had complete pathologically negative margins, occasional severe adverse events because of WBI, and long-term daily visits to radiation institutes.…”