Breast-conserving surgery is best for cancer

The results of two 20-year long studies into breast cancer treatments have shown that breast-conserving surgery results in better outcomes for women.

The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy

In the first study, which ran from 1973 to 1980, Italian researchers randomised 701 women with breast cancers 2 cm in diameter or smaller to undergo either radical mastectomy or breast-conserving surgery followed by radiotherapy (N Engl J Med, 2002; 347: 1227-32).

Tumour recurrence in the same breast occurred in 30 women who had breast-conserving surgery and in eight who had radical surgery. However, after 20 years, there was no significant difference in the rate of death from all causes, or in the occurrence of cancer in the other breast.

In the second study, US researchers evaluated the 20-year follow-up data from 1851 women with invasive breast cancer randomised to treatment with total mastectomy, lumpectomy alone, or lumpectomy and breast irradiation (N Engl J Med, 2002; 347: 1233-41).

Cumulative incidence of a recurrent tumour was 14.3 per cent in the lumpectomy-irradiation group and 39.2 per cent in the lumpectomy without irradiation group, suggesting that lumpectomy followed by breast irradiation continues to be an appropriate therapy for women with breast cancer.

There were no significant differences among the three groups in overall, disease-free or long-term disease-free survival. The researchers also noted that, although radiation therapy was associated with a marginally significant decrease in deaths due to breast cancer, this decrease was partially offset by an increase in deaths from other causes.

The same research team had earlier concluded that, over 25 years, radical mastectomy conferred no advantage over other less aggressive forms of mastectomy (N Engl J Med, 2002; 347: 567-75).