Young Breast Cancer Patients Undergoing Breast Conserving Surgery See Improved Prognosis

Excerpt:

“A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery. The analysis included 1331 patients younger than 40 years treated with breast conserving surgery and whole breast radiotherapy in a single cancer centre in Italy between 1997 and 2010.

“Breast cancer recurrences and deaths significantly decreased over time. A dramatic improvement in prognosis was observed after 2005, when the use of several new diagnostic and  were implemented in routine clinical practice.”

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Breast Conserving Surgery Plus RT Better Than Mastectomy in Some Patients

Excerpt:

“A large registry study found that certain breast cancer patients gain a significant survival benefit with breast conserving surgery plus radiation therapy (BCT) compared with mastectomy. This includes patients over the age of 50 with T1–2N0–1 disease, and other factors.

“Studies comparing those options have often excluded elderly patients, or those with existing comorbidities. The new study involved two time cohorts from a Netherlands registry, one with 55,802 patients diagnosed between 1999 and 2005, and another with 65,394 patients diagnosed between 2006 and 2012. The results were presented by Mirelle Lagendijk, MD, of the Erasmus MC Cancer Institute in Rotterdam, at the European Cancer Congress 2017 in Amsterdam.”

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Some Early Breast Cancer Patients Benefit More from Breast Conservation Than from Mastectomy

Excerpt:

“Breast conserving therapy (BCT, breast conserving surgery combined with radiation therapy) is superior to mastectomy in certain types of breast cancer patients, according to results from the largest study to date, to be presented to the European Cancer Congress 2017 today (Monday).

“Professor Sabine Siesling, from the Netherlands Comprehensive Cancer Organisation (IKNL) and University of Twente and Mirelle Lagendijk, MD, from the Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands, and colleagues from other hospitals, studied survival nationwide in nearly 130,000 , divided into two groups: those diagnosed between 1999-2005 and those diagnosed between 2006-2012. The patients selected from the Netherlands Cancer Registry had no metastases (spread of the cancer to organs other than the lymph nodes close to the tumour). To obtain information on cause of death, data were linked to the cause of death register.”

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Is Breast Conserving Therapy or Mastectomy Better for Early Breast Cancer?

Excerpt:

“Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT). This is because there is little evidence as to whether the greater risk of a return of the disease at the site of the original tumour after BCT is linked to a greater risk of the cancer spreading to other parts of the body, leading to higher death rates.

“Now, new research presented at the ESTRO 35 conference today (Saturday) has shown women aged younger than 45 years, who had early stage breast cancer that had not spread to the lymph nodes and who opted for BCT with radiation therapy, had a 13% higher risk of developing a local recurrence of their disease over a 20-year period than women who had a mastectomy and no radiation therapy. Furthermore, local recurrence doubled the risk of the cancer spreading elsewhere in the body (metastasis) and the risk of death was approximately two-thirds higher for BCT patients compared to mastectomy patients.”

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DCIS Surgery Outcomes Have Improved over Time

“Women with ductal carcinoma in situ (DCIS) treated with breast conserving surgery at Memorial Sloan Kettering Cancer Center in New York City from 1999 to 2010 had a 40% lower risk of cancer recurrence than those treated at the same institution between 1978 and 1998, a retrospective review of the prospectively maintained database has revealed.

“Five-year recurrence rates fell from 13.6% to 6.6% over these two periods and were limited to women who did not receive radiation therapy, Kimberly J. Van Zee, MD, MS, of Memorial Sloan Kettering Cancer Center reported at the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium, Sept. 25-27.

” ‘Since radiation is given only to reduce local recurrence rates and has never been shown to improve survival, a woman treated currently with breast conservation without radiation can expect about a 40% lower recurrence rate than in the earlier decades,’ said Van Zee.”


Low Axillary Recurrence/Mortality Among Older Women With Node-Negative Breast Cancer Undergoing Breast-Conserving Surgery Without Sentinel Node Biopsy

“In a single institution study reported in JAMA Surgery, Chung et al found a low axillary recurrence rate and low mortality among women with clinical T1–2N0 breast cancer aged ≥ 70 years who underwent breast-conserving surgery without sentinel node biopsy.

“The study involved 140 women treated at Cedars-Sinai Medical Center between January 2000 and December 2011. Patients had a median age of 83 years (range = 70–97 years); 74% had T1 tumors; 27% had grade 1, 44% grade 2, and 29% grade 3 tumors; 86% were estrogen receptor–positive; 73% were progesterone receptor–positive; 92% were HER2-negative; and 65% had ductal histology. Overall, 98% received chemotherapy, 76% radiotherapy, and 59% hormonal therapy…

“The investigators concluded: ‘Our study demonstrated low axillary recurrence and low mortality for patients with clinical T1–2N0 breast cancer who were 70 years of age or older and who underwent breast-conserving surgery without a sentinel node biopsy.’ “


Rates of Breast-Conserving Therapy for Early-Stage Breast Cancer Have Increased, Study Finds

“The number of women in the US undergoing breast-conserving therapy following a diagnosis of early-stage breast cancer has risen during the past 2 decades, according to a new study published in JAMA Surgery, though the authors reveal there are still barriers preventing women from receiving the treatment.

“After skin cancer, breast cancer is the most common cancer among American women, estimated to affect around 1 in 8 at some point in their lives.

“The majority of women diagnosed with breast cancer undergo some form of surgery, particularly if the cancer is diagnosed in the early stages. The surgical options available include mastectomy and breast-conserving therapy (BCT), or lumpectomy.

“While mastectomy involves full or partial removal of the breast tissue, BCT involves only the removal of the part of the breast containing the cancer.

“There are pros and cons with each procedure. With a mastectomy, a woman may lose an entire breast, while women who undergo BCT may be able to retain the majority of their breast tissue – making it a preferable option for many. However, women who have BCT often need to undergo radiation therapy for around 5-6 weeks following the surgery to ensure any remaining cancer cells are destroyed.”


Eligible for Breast Conserving Therapy, Many Still Choose Mastectomy

“No approved targeted therapies exist to treat triple-negative breast cancer, but new chemotherapeutic treatment strategies are helping shrink tumors so that less breast tissue needs to be removed during surgery. New research led by Brigham and Women’s Hospital in collaboration with the UNC Lineberger Comprehensive Cancer Center finds that breast-conserving therapy – or the removal of less breast tissue via a lumpectomy – was successful in more than 90 percent of the women who became eligible for this procedure after treatment with chemotherapy. Despite these findings, 31 percent who were eligible for breast conserving therapy chose to have the entire breast removed via mastectomy.

“The complete manuscript of this study and its presentation at the American Surgical Association’s 135th annual meeting today in San Diego, California, is anticipated to be published in the Annals of Surgery pending editorial review.

“ ‘We’ve shown that we can offer breast-conserving therapy to more women using these drug combinations, and if they convert, we’re really successful,’ said senior author David Ollila, MD, James and Jesse Millis Distinguished Professor of Surgery at University of North Carolina School of Medicine, co-director of the UNC Breast Program and a member of the UNC Lineberger Comprehensive Cancer Center.  ‘We have more and more women eligible for breast preservation, and still we saw more than 30 percent of women choosing mastectomy.’ “


Axillary Lymph Node Evaluation Performed Frequently in Ductal Carcinoma in Situ

“Axillary lymph node evaluation is performed frequently in women with ductal carcinoma in situ breast cancer, despite recommendations generally against such an assessment procedure in women with localized cancer undergoing breast-conserving surgery, according to a study published online by JAMA Oncology.

“While axillary lymph node evaluation is the standard of care in the surgical management of invasive breast cancer, a benefit has not been demonstrated in ductal carcinoma in situ (DCIS). For women with invasive breast cancer, sentinel lymph node biopsy (SLNB) replaced full axillary lymph node dissection (ALND). The sentinel nodes are the first few lymph nodes into which a tumor drains.

“Guidelines published by the American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend against axillary evaluation in women undergoing breast-conserving surgery (BCS). If invasive cancer were to be discovered SLNB could be performed at a later date. But because a total mastectomy precludes future SLNB, the guidelines suggest SLNB may be appropriate for some high-risk patients because axillary evaluation would be indicated if invasive cancer was found, according to background in the study.”