Patients Who Undergo Preoperative Chemotherapy More Likely to Forgo Mastectomy

Better chemotherapy drugs lead to increased usage prior to breast operations over last 5 years.

The impact of more effective chemotherapy drugs for the treatment of breast cancer may have contributed to more patients forgoing a mastectomy over the last 5 years, a recent study finds.

The study, published online in the Journal of the American College of Surgeon Patients, notes that patients with larger malignant tumors who receive preoperative chemotherapy are more likely to choose a breast-preserving procedure instead of a mastectomy.

Researchers from Yale University School of Medicine and Yale University Comprehensive Cancer Center found that neoadjuvant therapy rates experienced a significant jump over the course of the 5-year study period, potentially as a result of superior FDA-approved chemotherapy drugs.

"We've seen data published from clinical trials showing that neoadjuvant chemotherapy results in increased lumpectomy rates, but this is really one of the first studies using a large national database that reflects what is also going on in the community hospital setting," lead investigator Brigid K. Killelea, MD, MPH, FACS, said in a press release.

The researchers analyzed data from the National Cancer Data Base, which records an estimated 70% of newly diagnosed cancer cases in the United States from approximately 1500 cancer programs.

The study included a total of 354,204 women with invasive breast cancer from 2006 to 2011 who received breast operations and chemotherapy before or after their procedures, or both. Of those patients, 16.7% received chemotherapy prior to their operations.

This study did not examine overall survival in women who received preoperative chemotherapy, which previous trials found to be similar to adjuvant chemotherapy. The study did, however, confirm higher rates of breast conservation in patients with larger tumors who received chemotherapy first.

Additionally, 35% of patients who had preoperative chemotherapy had breast conservation therapy as well.

"One interesting thing that we saw over time was that the percentage of women that did receive neoadjuvant therapy increased, going from 13.9 percent to 20.5 percent from 2006 to 2011," Dr. Killelea said.

Dr. Killelea further noted that advances in chemotherapy drugs since 2006 have generated more effective treatments for serious forms of breast cancer, such as HER2-positive and triple negative cancers. In these patients, preoperative chemotherapy allows surgeons to consider how the tumor may respond to treatment, according to the study.

This also allows doctors to immediately start treating cancer that has spread to lymph nodes instead of waiting for the breast to heal following the procedure, according to the study.

"Going forward, it will be interesting to see whether or not the use of neoadjuvant therapy continues to rise as newer drugs and agents are being developed all the time," Dr. Killelea said. "It will also be interesting to watch what happens to the rate of breast conservation over time. We don't know. That's why it's so important for us to have a database like NCDB."