Breast-conserving treatment linked with higher survival than mastectomy in early-stage breast cancer

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1. Breast-conserving therapy (BCT) is associated with greater overall and disease-specific survival benefit than mastectomy for early-stage breast cancer, regardless of age and tumor hormone receptor status.

2. The benefit of BCT is greatest for women older than 50 years with HR-positive disease.

Among breast cancer treatment options, there has been a recent increased preference for mastectomy over BCT. This trend is driven in part by a perception of worse outcomes among women receiving BCT for tumors with unfavorable factors such as young age and HR+ disease. However, this study demonstrates significantly greater survival rates among patients receiving BCT than mastectomy, regardless of age or HR tumor status. This large retrospective study was highly powered and showed significant results in the favor of BCT, though as with all observational trials causation remains elusive. These findings may dispel the perception that BCT leads to worse outcomes, especially among older women with HR+ tumors. Translation of these findings into clinical practice may lead to improved survival for early-stage breast cancer patients.

Click to read the study in Cancer

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Image: PD

1. Breast-conserving therapy is associated with greater overall and disease-specific survival benefit than mastectomy for early-stage breast cancer, regardless of age and tumor hormone receptor status.

2. The benefit of BCT is greatest for women older than 50 years with HR-positive disease.

This [retrospective cohort] study compared survival rates between women with stage I or II breast cancer who were treated with either breast-conserving therapy (BCT, i.e. lumpectomy and radiation) or mastectomy between 1990 and 2004. Disease-specific and overall survival rates were stratified by age group and tumor hormone receptor (HR) status. Breast-conserving therapy was associated with improved overall survival, regardless of age and HR status (adjusted hazard ratio = 0.81, CI = 0.80-0.83). Women older than 50 with HR-positive tumors experienced the greatest survival benefit – a 19% lower overall mortality with BCT as compared to mastectomy.

Further reading:

1. Breast conserving therapy

2. Mastectomy

3. Hormone receptors in breast cancer: Clinical utility and guideline recommendations to improve test accuracy

In sum: Among breast cancer treatment options, there has been a recent increased preference for mastectomy over BCT. This trend is driven in part by a perception of worse outcomes among women receiving BCT for tumors with unfavorable factors such as young age and HR+ disease. However, this study demonstrates significantly greater survival rates among patients receiving BCT than mastectomy, regardless of age or HR tumor status. This large retrospective study was highly powered and showed significant results in the favor of BCT, though as with all observational trials causation remains elusive. These findings may dispel the perception that BCT leads to worse outcomes, especially among older women with HR+ tumors. Translation of these findings into clinical practice may lead to improved survival for early-stage breast cancer patients.

Click to read the study in Cancer

By [EK] and [AB]

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