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Survival Similar With Breast Conservation vs. Mastectomy After Nearly 20 Years: Presented at SABCS

By Andrew Bowser

SAN ANTONIO, TX -- December 13, 2002 -- Mastectomy and breast conservation surgery for early-stage breast cancer are associated with similar survival rates nearly 20 years after the procedures were performed, according to results of one of the longest follow-ups to date among the seven trials that have compared the two modalities.

There was no significant difference in survival or disease recurrence between the modalities, according to the results, which were presented here December 12^th at the 25^th Annual San Antonio Breast Cancer Symposium.

Notably, some of the patients in the breast conservation group did not have negative margins, said Matthew M. Poggi, MD, of the Radiation Oncology Branch of the National Cancer Institute (NCI), Bethesda, Maryland, United States.

However, while negative margins were not required for trial entry, investigators could not report whether survival was different vs. mastectomy for the women who did not have clear margins.

"Unfortunately, due to referring patterns and inaccessibility to complete pathologic specimens, we are unable to correlate margin status with in-breast events or other cancer events," Dr. Poggi said.

This NCI study included 247 patients with stage I-II breast cancer randomised to modified radical mastectomy, or to lumpectomy, axillary dissection and radiation therapy.

After a median follow-up of 18.4 years, overall survival was 58 percent in the mastectomy group and 54 percent in the lumpectomy plus radiation group. In addition, disease-free survival at this follow-up point was 67 percent for mastectomy and 63 percent for lumpectomy and radiation.

Early on, there was a significant difference in survival after second cancer events (either recurrence or second primary cancer). Probability of survival was 97 percent for mastectomy compared with 59 percent in the breast conservation group; but after the first year, the probabilities were comparable and overall survival was not statistically different, according to the investigators.

"These findings contribute to the growing body of research that suggests that lumpectomy can be just as effective as mastectomy in treating breast cancer," Dr. Poggi said.

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