Breast Cancer Patients Opt for Lumpectomy with Radiation Treatment

Women increasingly choosing surgery to remove both breasts.

Treatment patterns for ductal carcinoma in situ (DCIS) show a shift in the amount of women opting for lumpectomy in combination with radiation since the 1990’s rather than single-breast mastectomy.

Researchers also found an increased tendency for women to opt for the removal of both breasts, despite their analysis that cancer survival rates remained similar across treatment forms.

These findings raise many questions about the ongoing debate about the best way to treat the non-invasive, yet potentially early cancer cells that define DCIS.

“With this analysis, we sought to determine what treatment women selected when diagnosed with DCIS, and whether there was any impact in mortality with the different treatments,” said senior author E. Shelley Hwang, MD, chief of breast surgery at the Duke Cancer Institute. “This is an important women’s health issue, and we still do not have enough data around what the best treatment is. Studies like ours should be viewed as a call for well-designed clinical trials that could provide more information to better guide both doctors and patients.”

Data from the Surveillance, Epidemiology, and End Results (SEER) program in the United States was analyzed by Hwang and colleagues. The data was from more than 121,000 cases between 1991 and 2010 in which women were diagnosed with DCIS.

The researchers discovered that patients in general have opted for less extensive surgery over time, with rates of single mastectomy declining from 44.9% to just 19.3%, while rates of lumpectomy and radiation increased to 46.8% from 24.2%.

Sentinel node biopsies were also a highly-utilized treatment option instead of the more extensive axillary dissections, in which numerous lymph nodes are removed.

However, these trends come with their own downside of a rise in double mastectomies, from 0 to 8.5%, often in younger women.

Disparities in overall survival were associated with the types of treatment used, indicating that differences in general health may impact treatment choice.

An 89.6% 10-year overall survival rate was observed among patients who opted for a lumpectomy combined with radiation, closely followed by an 86.1% survival rate in those who had mastectomy and 80.6% in those who had lumpectomy alone.

However, when the researchers observed breast cancer deaths at 10 years, they found virtually identical rates between the treatment groups.

Ten-year breast cancer survival rates were 98.9% for those who opted for lumpectomy and radiation treatment, 98.5% for only mastectomy and 98.4% for lumpectomy alone.

“One of the things we wanted to examine was what happened to these women after they were diagnosed with DCIS,” Hwang said. “Overall, 9.2% of all deaths were due to breast cancer. However, the predominant cause of death was not breast cancer, but cardiovascular disease, which accounted for 33% of all deaths.”

Hwang noted that the exception was among women who were younger than 50 years of age with DCIS, where approximately 33% of deaths resulted from breast cancer, indicating a strong need for more aggressive forms of treatment for those patients.

“What our study shows is that we urgently need clinical trials to know whether we are doing the right thing for this group of patients,” Hwang said. “This is not a question of providing no treatment or providing overly aggressive treatment, it’s an issue of providing the right individualized treatment for a group of patients with an excellent prognosis regardless of what treatment they receive. We need more and better evidence for the therapies we recommend to each individual patient to make sure that our interventions are indeed benefitting them.”