For Breast Cancer, Radiation Plus Breast-Saving Surgery Saves Lives

Breast cancer patients who get both radiotherapy and breast-sparing surgery have better outcomes for up to 10 years after diagnosis, according to a retrospective study presented at the European Breast Cancer Conference (EBCC). The study included 10,000 breast cancer patients with ductal carcinoma in situ (DCIS).

For the first 10 years after diagnosis, DCIS recurred in 4.6% of patients who got breast-saving surgery and radiotherapy, while it recurred in 13.0% of patients who did not get radiotherapy. At 10 years after diagnosis, the risk of recurrence of invasive breast cancer was 5.2% for those who got radiotherapy and 13.9% for those who did not. After 10 more years, the recurrence rates for those who did and did not get radiotherapy were 2.8% and 1.2%, respectively, for DCIS and 13.2% and 11.8%, respectively, for invasive disease.

Said Dr. Maartje van Seijen of the Netherlands Cancer Institute, Amsterdam:

“This study shows that, overall, the addition of radiotherapy gives women the best chances.”

She cautioned that a different DCIS or invasive cancer could still develop, regardless of treatment of the original cancer.

Added Dr. van Seijen:

 “In a very small number of women, radiotherapy itself might cause a new breast cancer, often many years after the radiotherapy was given.”

Authors of an English study presented at the EBCC concluded that surgery should be considered for all older women with hormone receptor (HR)-positive breast cancer, as long as the patient was not too frail. Their study was in 3,000 women over age 70 with operable, HR-positive breast cancer. While 82% had surgery, the remainder of the study patients got antiestrogen therapy. During follow-up, only 14.6% of the women who had surgery died. However, 41.8% of the women on antiestrogen therapy alone died. Of those who died specifically from breast cancer, 4.9% had had surgery and 9.5% had not. Those who had surgery were younger and fitter to begin with.

A comparison of 676 women of similar age, frailty levels, and fitness levels found that 25.6% of those who had surgery died but 34.5% of those who did not have surgery died during study follow-up. No one died from having surgery and only 2% had a major adverse event related to surgery.

Based on the study results, Dr. Lynda Wyld of the University of Sheffield concluded that surgery helps with survival for most women, as long as they are fit enough to begin with. She noted that in the oldest, frailest women, not only did surgery not extend life, it also appeared to reduce quality of life. The study specifically found that hormone therapy was “unlikely to be inferior”  for women with cancer  “who are unfit for surgery or have a life expectancy of <4 years.”

retrospective review of 1,102 patients found that women diagnosed with high-risk breast cancers at times other than a scheduled mammogram were more likely to die than women whose cancer was detected during a regularly scheduled mammogram.

Breast cancers discovered in between regular screening mammograms, the so-called interval cancers, are more likely to be aggressive, be of higher grade or stage, be larger size, and lack estrogen or progesterone receptors, according to the Journal of the National Cancer Institute. About 85% of women with interval breast cancers were likely to be alive 8 years after diagnosis, whereas close to 94% of women whose high-risk tumors were detected by mammogram were likely to be alive after 8 years. However, for women whose tumors were ultra-low risk and genomically low risk, eight-year survival rates were similar, at 97%-98% and 92%-94%, respectively.

Said Dr. Josephine Lopes Cardozo of the Netherlands Cancer Institute:

“This suggests that the method of detection is an additional prognostic factor in this group of patients. The method of detection, combined with the 70-gene signature, can further optimize treatment for patients at high risk of recurrence…. For patients with a very low risk of recurrence, longer follow-up may also help to identify those who are currently at risk of being overtreated.”

A Canadian study likewise showed that women with interval breast cancers were far more likely to die of breast cancer.

Disclaimer: This article does not provide medical advice. Do not take action based solely on this article and always consult with an appropriate healthcare professional. This article is purely for informational purposes.

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