WebMD Medical News
Laura J. Martin, MD
Oct. 20, 2011 -- Women with early breast cancer often consider breast-conserving surgery in which a doctor removes the tumor but spares the rest of the breast. But they may worry that their cancer is more likely to come back if they don't remove the entire breast.
New research shows that adding radiation therapy to breast-conserving surgery halves the chance that cancer will come back and reduces the risk of dying from breast cancer, when compared to the breast-conserving surgery alone.
The study is published in TheLancet.
Breast cancer experts tell WebMD that the new findings should provide some peace of mind for women with early breast cancer who choose breast-conserving surgery plus radiation over mastectomy -- the complete removal of the breast or breasts.
In 2011, an estimated 230,480 women will be diagnosed with breast cancer, according to the American Cancer Society. About 39,520 women will die from the disease in 2011.
The new study included close to 11,000 women who took part in 17 studies. The women were followed for about 10 years on average.
After 10 years, 35% of women who had breast-conserving surgery without radiation had a breast cancer recurrence. By comparison, 19% of women who had radiation after their breast-sparing surgery experienced a recurrence.
The study also looked at overall survival. After 15 years, 25% of women who did not have radiation had died from breast cancer, compared with 21% of these women who had both surgery and radiation. Adding radiation to treatment reduced the rate of dying from breast cancer by one-sixth, the study shows.
"For breast cancer patients treated with a lumpectomy, the addition of radiation significantly reduces the chance of the cancer coming back and most importantly improves the overall chance of ... being cured," says Thomas A. Buchholz, MD, in an email.
Buchholz, a professor and chair of the department of radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston, wrote an editorial that's published with the new study.
"The findings indicated conclusively the high benefits of radiation after lumpectomy and that these benefits persist over the entire life span of the patient. The study clearly shows that treatment at the time of diagnosis with radiation is a much better strategy than saving the treatment and using it for the patients at the time of a recurrence."
Stephanie Bernik, MD, chief of surgical oncology at Lenox Hill Hospital in New York, says the new findings are reassuring for women. "This gives us more confidence to say that breast-conservation surgery plus radiation is a good choice for some women with early breast cancer."
Elizabeth Comen, MD, says the findings underscore the importance of following breast-conserving surgery with radiation. She is a breast oncologist at Memorial Sloan-Kettering Cancer Center in New York City.
"It's reassuring and reaffirms what we already know," she says. "We always opt to preserve the breast when we can for aesthetic reasons and because a mastectomy is a bigger surgery."
"Radiation plus lumpectomy is equal to mastectomy in terms of survival for women with early-stage breast cancer," Comen tells WebMD.
But not every woman with early breast cancer is a candidate for breast-conserving surgery. Some women may need a mastectomy based on the size of their tumor and/or other risk factors, she says.
Radiation is safe, Comen says. Side effects may include fatigue and/or skin irritation. "The way we give radiation today is so targeted and experts are so good at avoiding vital organs."
Some women with connective tissue diseases such as lupus and other certain medical conditions may not be candidates for radiation.
The new findings may cause the pendulum to swing back in favor of breast-conserving therapy with radiation over mastectomy in certain women, says Marisa Weiss, MD. She the president and founder of Breastcancer.org and the director of Breast Radiation Oncology and Breast Health Outreach at Lankenau Hospital in Wynnewood, Pa., as well as a breast cancer survivor.
There has been an attitude among women that "the more they take off, the better," she says. As a result, "fears sort of permeated and when women are diagnosed, it is more common to choose mastectomy."
"This study gives women more confidence that breast preservation therapy is a very powerful way to treat early stage breast cancer," Weiss tells WebMD. Adding radiation to the mix also lowers the risk of recurrence and their risk of dying compared to breast-conserving therapy alone.
SOURCES:Marisa Weiss, MD, president and founder, Breastcancer.org; director, Breast Radiation Oncology and Breast Health Outreach, Lankenau Hospital, Wynnewood, Pa.Elizabeth Comen, MD, breast oncologist, Memorial Sloan-Kettering Cancer Center, New York City.Stephanie Bernik, MD, chief of surgical oncology, Lenox Hill Hospital, New York City.American Cancer Society web site: "What is the key breast cancers statistic?"Thomas A. Buchholz, MD, professor and chair, department of radiation oncology, University of Texas M.D. Anderson Cancer Center, Houston.Buchholz, T.A. The Lancet, published online Oct. 20, 2011.
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