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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Recommendation to Omit Radiation Therapy After Lumpectomy Is Not Frequently Implemented

“Nearly two thirds of U.S. women age 70 or older with stage I breast cancer who undergo lumpectomy and are eligible to safely omit subsequent radiation therapy (RT) according to national cancer guidelines still receive this treatment, according to new study results. The researchers looked at more than 205,000 cases of breast cancer nationwide, and their study is published as an ‘article in press’ on the Journal of the American College of Surgeons website in advance of print publication.

“After a lumpectomy, also called a breast-sparing or breast-conserving operation, radiation usually is given to the breast to reduce the chance of the cancer returning. However, treatment recommendations changed in 2004 for a select group of elderly breast cancer patients after research found that postoperative RT did not significantly prolong their survival over five years compared with women who received no RT.”


For Lung Cancer Patients, IMRT Associated with Lesser Side Effects, Better Tolerance of Chemotherapy, Compared to Conventional Radiation Therapy

“An analysis of an international, cooperative-led trial of patients with locally advanced non-small cell lung cancer (NSCLC) has shown that those who received intensity modulated radiation therapy (IMRT) had less severe lung toxicity and were able to better tolerate their chemotherapy, compared to patients who received 3-dimensional conformal radiation therapy (3-D CRT).

“Stephen Chun, M.D., fellow, Radiation Oncology at The University of Texas MD Anderson Cancer Center, presented the research at the American Society for Radiation Oncology’s 57th Annual Meeting.

“According to the American Cancer Society, in the United States, 221,200 will be diagnosed with lung cancer in 2015 and 158,040 will die from the disease — making it the deadliest of all cancers. About a third of all lung cancers are diagnosed when the cancer is locally advanced, said Chun. The standard of care for locally advanced lung cancer is concurrent chemotherapy and radiation, with most patients receiving either 3-D CRT or IMRT.”


Delay in Treatment, Missed Diagnostic Testing Found Among Lung Cancer Patients

“Patients undergoing surgery for lung cancer may wait too long to receive treatment, and too many patients skip vital diagnostic steps that are needed to help determine the best possible treatment, according to an article in the August 2015 issue of The Annals of Thoracic Surgery.

“The 5-year relative survival of all patients diagnosed with lung cancer in the United States is approximately 17%, according to the National Cancer Institute, and has changed little in the last 30 years. Fewer than half of all patients who undergo surgery for lung cancer survive as long as 5 years.

“Nicolas Faris, MDiv and Raymond Osarogiagbon, MBBS led a group of researchers from Baptist Cancer Center and the University of Memphis in Tennessee, who reviewed hospital records for all patients who underwent surgery for suspected lung cancer at Baptist Memorial Hospital between January 2009 and June 2013. Using only patients who had surgery for suspected lung cancer, the researchers examined how long it took to begin care and what steps were taken to determine appropriate treatment.”


Promising New Drug Combo Offers Hope for People Battling Melanoma

“Summer inspires many people to think about their vacation plans; it makes Montaser Shaheen, MD, think about melanoma. Shaheen is a medical oncologist at the University of New Mexico Cancer Center. He and colleagues from around the country recently published a paper in the New England Journal of Medicine about a promising new treatment for melanoma. Shaheen ran the UNM Cancer Center’s portion of the clinical trial from which the paper’s data was collected. He hopes to be able to offer the melanoma treatment to more people.

“Melanoma doesn’t strike often but it can be deadly when it does: it accounts for only two percent of all skin cancers but causes most skin cancer deaths. Once it has spread from the original tumor site, melanoma is particularly difficult to treat. Chemotherapy, the standard treatment, causes the tumor to shrink in only about 10 percent of the people treated.

“The treatment Shaheen and his colleagues tested in the clinical trial caused tumors to shrink in 61 percent of the people treated. In another 22 percent, the tumors disappeared completely. ‘This is a revolutionary therapy,’ Shaheen says. ‘The efficacy is dramatic for melanoma. More than 70 percent [of people treated] benefit.’ “


Stereotactic Ablative Radiotherapy Achieves Better Overall Survival than Surgery for Early Lung Cancer

“Patients with operable stage I non-small cell lung cancer (NSCLC) could achieve better overall survival rates if treated with Stereotactic Ablative Radiotherapy (SABR) rather than the current standard of care — invasive surgery — according to research from a phase III randomized international study from The University of Texas MD Anderson Cancer Center.

“The findings, published today in The Lancet Oncology, are from the first randomized clinical trials comparing SABR and surgery.

” ‘For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,’ said the first author and principal investigator Joe Y. Chang, M.D., Ph.D., professor, Radiation Oncology. ‘Stereotactic radiation treatment is a relatively new approach for operable early stage lung cancer, while surgery has been the standard for a century. This study can give physicians confidence to consider a non-invasive option.’ “


Moderate Exercise May Make Cancer Treatments More Effective, Kinesiologist Finds

“Kansas State University kinesiology research offers encouraging information for cancer patients: A brisk walk or a slow jog on a regular basis may be the key to improved cancer treatments.

“Brad Behnke, associate professor of exercise physiology, and collaborators have shown that moderate exercise on a regular basis enhances tumor oxygenation, which may improve treatments in cancer patients. Now Behnke is using a $750,000 American Cancer Society grant to study moderate exercise as a way to make radiation treatments more effective, especially for difficult-to-treat tumors.

” ‘If we can increase the efficacy of radiation treatment, then the patient’s prognosis is enhanced,’ Behnke said. ‘An intervention like exercise has almost universally positive side effects versus other treatments that can have deleterious side effects. Exercise is a type of therapy that benefits multiple systems in the body, and may permanently alter the environment within the tumor.’

“The National Cancer Institute at the National Institutes of Health recommends exercise for cancer patients and cancer survivors, but little research shows what happens within the tumors during such exercise. That prompted Behnke to combine his expertise in integrative physiology with cancer research. He also has received support from the university’s Johnson Cancer Research Center.”


New Studies Examine the Significant Risk of Life-Threatening Blood Clots in Post-Surgical Lung Cancer Patients

“New evidence suggests that lung cancer surgery patients are at higher risk of developing venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), than previously thought, with elevated risks of complications or death. When thromboemboli occur, they may be asymptomatic or attributed to post-surgical pain or complications, and may reflect both the lung cancer itself as well as compromised lung function after surgery. These incidents may also be ascribed to an inconsistent approach to prevention that currently exists among thoracic surgeons and hematologists who care for these patients. Three presentations at the 95th Annual Meeting of the American Association for Thoracic Surgery explore the problem of venous thromboembolism (VTE) after surgery for lung cancer.

“Symptoms of PE include breathing difficulties that begin suddenly, rapid breathing, rapid heart rate, chest pain, cough, coughing up blood, fainting, and sense of impending doom. Common symptoms of DVT are lower-extremity swelling, localized warmth and tenderness, fever, and cyanosis. The effects of VTE range from mild to life-threatening.

“In the first report, Yaron Shargall, MD, who is Head of the Division of Thoracic Surgery and holds the Juravinski Professorship in Thoracic Surgery at McMaster University (Hamilton, ON), and colleagues from McMaster University (Hamilton) and the University of Toronto will present the results of the first prospective analysis of the incidence of VTE following oncologic lung resection as part of the General Thoracic Surgery Moderated Poster Competition. This study, funded by the Heart and Stroke Foundation of Canada, looked at outcomes for 157 patients who underwent thoracic surgery for primary lung cancer (89.9%) or metastatic cancer (6.3%). All patients received blood thinners (unfractionated heparin or low molecular weight heparin) and mechanical VTE preventative treatment (graduated compression stockings) from the time of surgery until leaving the hospital.”


Favorable 15-Year Survival Outcomes for Older Prostate Cancer Patients with Low-Risk Disease

“Previous research by the study’s lead author Grace Lu-Yao, PhD, MPH, cancer epidemiologist at the Cancer Institute of New Jersey and professor of medicine at Rutgers Robert Wood Johnson Medical School, and colleagues examined 10-year outcomes for this population (JAMA, Vol. 302, No. 11). The 2009 research showed men diagnosed with prostate cancer beginning in the early 1990’s had significantly improved survival compared with patients whose cancers were diagnosed in prior decades. Given the protracted nature of the disease and increasing longevity among elderly men, 10-year follow-up may not be sufficient to make informed treatment decisions. Dr. Lu-Yao notes this new study, which extends data examination by an additional five years, ‘helps provide a more complete picture of potential outcomes for patients who have a life expectancy greater than 10 years.’

“The new research, which appears in the current online edition of European Urology (doi: 10.1016/j.eururo.2015.03.021), examined 33,137 Medicare patients aged 65 or older who were diagnosed with early-stage (T1 or T2) prostate cancer from 1992 through 2009 and received conservative management (no surgery, radiotherapy, cryotherapy or androgen deprivation therapy) within the first six months of diagnosis. The researchers utilized information from the Surveillance, Epidemiology and End Results (SEER) cancer registries and Medicare claims. All SEER registries hold the highest level of certification of data quality.

“Investigators found that men aged 64 to 74 with a Gleason score (a grading system that indicates how likely a tumor will spread) of between five and seven had a lower risk (5.7 percent) of dying from prostate cancer over a 15-year period as compared to men 75 and older, whose risk was 10.1 percent. For men with the highest level Gleason scores (between eight and 10), 15-year prostate cancer mortality rates were 22 percent for men aged 65 to 74 and 27 percent for men 75 and older.”