Young women with early-stage breast cancer have similar survival rates with a lumpectomy and radiation treatment, known as breast conservation therapy, as with mastectomy, a new study conducted at the University of Maryland has found. The results of the analysis of nearly 15,000 patients listed in a nationwide cancer registry will be presented at the 2011 Breast Cancer Symposium to be held Sept. 8-11 in San Francisco.
Steven Feigenberg, MD, a radiation oncologist at the University of Maryland Marlene and Stewart Greenebaum Cancer Center and an associate professor of radiation oncology at the University of Maryland School of Medicine, says that mastectomies among young women have been on the rise, in part because of concerns regarding recurrence of their cancer.
"We believe these findings are very significant for young women with early-stage breast cancer who might choose to have a mastectomy in the hope of improving their outcome. This study confirms that breast-conservation therapy is a safe, effective treatment option and will not have a detrimental effect on survival," says Feigenberg, the study's senior author (pictured).
He says this is the largest study to date to compare survival in young women with early-stage breast cancer who had breast-conservation therapy vs. mastectomy. Women under 40 can have more aggressive tumors and are often at higher risk for having their cancer recur. Previous studies have suggested that young women have higher local recurrences of their cancer with breast conservation therapy, but these studies did not demonstrate an effect on survival, Feigenberg says.
Usama Mahmood, MD, the lead author, says, "We looked at data from nearly 15,000 women in our retrospective analysis and saw no difference in survival between those who had breast-conservation therapy and those who had a mastectomy." Mahmood, a former resident in the Department of Radiation Oncology at the University of Maryland who is now at the University of Texas MD Anderson Cancer Center, will present the data at the Breast Cancer Symposium.
E. Albert Reece, MD, PhD, MBA, vice president of medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, says, "This large analysis breaks new ground in advancing what we know about how to treat young women with early-stage breast cancer. It will most certainly help young women and their doctors to better understand the most appropriate treatment options and make decisions based on what's best for each patient."
Researchers analyzed data from the SEER (Surveillance, Epidemiology, and End Results) registry, which is maintained by the National Cancer Institute. They identified 14,764 women, age 20 to 39, who were diagnosed with early-stage breast cancer between 1990 and 2007. Forty-five percent of the women had breast conservation surgery, and 55 percent had a mastectomy. Patients who received breast conservation therapy were older and had smaller, lower-grade tumors and less lymph-node involvement. The median follow-up was nearly six years, although some patients were followed for 10 years, 15 years, and beyond. All of the breast cancers were early-stage. Sixty-four percent of the patients were white.
To confirm the results of the study, the researchers did a matched pair analysis, using a smaller group of 4,644 patients who had undergone breast conservation therapy or a mastectomy. Patients were matched for such factors as year of their diagnosis, age, grade, tumor size, number of positive lymph nodes, the number of nodes removed, and their particular type of breast cancer, and still there was no difference in overall survival or survival specific to breast cancer. Similarly, a separate analysis was performed on the youngest group of patients, under age 33, again seeing no difference in outcomes.
The overall survival for those who had breast conservation therapy was 92.5 percent after five years, 83.5 percent after 10 years, and 77 percent after 15 years. That compares with 91.9 percent, 83.6 percent, and 79.1 percent, respectively, for those who had mastectomies. In addition, the breast cancer-specific survival rates were similar between the two groups.
The study's authors include members of the multidisciplinary breast cancer team at the University of Maryland Greenebaum Cancer Center. In addition to Feigenberg, co-authors include Katherine Tkaczuk, MD, a medical oncologist who heads the Breast Evaluation and Treatment Program; Susan Kesmodel, MD, a surgical oncologist; and two medical oncologists, Saranya Chumsri, MD, and Ting Bao, MD.
The 2011 Breast Cancer Symposium is a three-day multidisciplinary symposium, sponsored by the American Society of Clinical Oncology, American Society of Breast Disease, the American Society of Breast Surgeons, the American Society for Radiation Oncology, the National Consortium of Breast Centers and the Society of Surgical Oncology.
About the University of Maryland Marlene and Stewart Greenebaum Cancer Center
The University of Maryland Marlene and Stewart Greenebaum Cancer Center is a National Cancer Institute-designated cancer center, which is part of the University of Maryland Medical Center and the University of Maryland School of Medicine. The center is recognized for its active clinical and basic science research program. It has comprehensive programs to treat all types of cancer and is a major referral center for patients throughout Maryland and the region. It has been recognized as one of the top 25 cancer centers in the nation by U.S. News and World Report in 2011.
For more information about the center, go to www.umgcc.org.