“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 treatment strategies were implemented in routine clinical practice.”
“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.”
“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 breast cancerpatients, 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.”
“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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“Roughly 5 years ago, a study demonstrated that neoadjuvant endocrine therapy increases the rates of breast conservation surgery in patients with breast cancer as a result of the downstaging of disease.
“Now, an analysis of roughly 80,000 women with breast cancer in the United States shows that this study has done little to increase the use of this treatment modality.
” ‘Neoadjuvant endocrine therapy use has increased since the publication of Z1031 [the American College of Surgeons Oncology Group (ACOSOG) Z1031 study]. However, the overall rate of neoadjuvant endocrine therapy use is low, at 3.2%,’ said Akiko Chiba, MD, a breast surgery fellow at the Mayo Clinic, Rochester, Minnesota, who presented the study at the Society of Surgical Oncology (SSO) 2016 Cancer Symposium.”
“For some early stage breast cancer patients, accelerated partial breast irradiation (APBI) using multicatheter brachytherapy following breast conserving surgery may be an excellent treatment option, as it has now been proven to be as effective as the current standard treatment – whole breast irradiation (WBI) – in local control, disease-free and overall survival rates, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting.
“Breast cancer patients often receive radiation therapy (RT) after breast-conserving surgery to help lower the chance that the cancer will recur or metastasize in the nearby lymph nodes. WBI using external beam radiation is a longstanding standard RT for breast cancer patients, during which the entire breast and often the surrounding chest area receives radiation for several weeks, followed by an extra boost of radiation to the area where the cancer was removed. Many women in the U.S. who are eligible for breast conserving surgery still choose to undergo mastectomy in the hopes that it will make subsequent WBI unnecessary, due largely to the long-duration of WBI and/or because of fears concerning the potential side effects of radiation to surrounding organs.”
“Anees B. Chagpar, MD, MA, MPH, MBA, FRCS(C), FACS, associate professor of surgery (oncology), director, The Breast Center at Smilow Cancer Hospital at Yale-New Haven, assistant director, Global Oncology, Yale Comprehensive Cancer Center, discusses initial results of the SHAVE trial for patients with breast cancer.
“The majority of women annually diagnosed with early-stage breast cancer will opt for breast conserving surgery. The objective of this procedure, Chagpar explains, is to ensure that no cancer touches the edge of the specimen. For patients with positive margins, surgeons often remove more tissue during a second surgery. The SHAVE trial examined the efficacy of greater cavity shaving in the first surgery as opposed to a second.
“The randomized SHAVE trial permitted surgeons to conduct breast conserving surgery as they normally would. Before closing the procedure, in the operating room, surgeons were randomized to either close the surgery or remove more tissue around the cavity. Results showed that more cavity shaving demonstrated a 50% decrease in reexcision rates and positive margin rates. This did not affect complication rates or patients’ perspective on their cosmetic outcomes, Chagpar says.”
“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.”
University of North Carolina at Chapel Hill School of Medicine | Apr 23, 2015
“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.’ “