Outcomes Equal With XRT vs. Mastectomy
Posted 11/21/2010
Posted in
This study reinforces what we have been told for years: that, in most circumstances, women do equally well whether they are treated with mastectomy or with lumpectomy/radiation for early stage breast cancer. There are always particular situations in which a mastectomy is indicated: a second cancer or a local recurrence in a previously radiated breast, a large tumor (removal would leave a very disfigured breast), a central location of a tumor (same reason), or other individual circumstances. In any of these cases, your surgeon will recommend a mastectomy and explain the reasons. Bottom line: if your surgeon is telling you that either surgery is equally safe and effective, you can believe her.
Over the years, I have worked with some women who, no matter what their doctors told them, just could not feel comfortable without a mastectomy. You know yourself best. If you believe that keeping your breast is going to keep you awake at night, worrying, for the rest of your life, you might opt for a mastectomy in spite of the reassurance that it is not medically necessary. From my perspective, "Medically necessary" also includes your mental health.
Here is an excerpt and then a link to read the article:
Outcomes following local therapy for early-stage breast cancer
in non-trial populations
Nancy L. Keating • Mary Beth Landrum •
John M. Brooks • Elizabeth A. Chrischilles •
Eric P. Winer • Kara Wright • Rita Volya
Abstract Recent studies suggest trends toward more
mastectomies for primary breast cancer treatment. We
assessed survival after mastectomy and breast-conserving
surgery (BCS) with radiation for early-stage breast cancer
among non-selected populations of women and among
women similar to those in clinical trials. Using population-
based data from Surveillance Epidemiology, and End
Results cancer registries linked with Medicare administra-
tive data from 1992 to 2005, we conducted propensity score
analysis of survival following primary therapy for early-
stage breast cancer, including BCS with radiation, BCS
without radiation, mastectomy with radiation, and mastec-
tomy without radiation. Adjusted survival was greatest
among women who had BCS with radiation (median sur-
vival = 10.98 years). Compared with this group, mortality
was higher among women who had mastectomy without
radiation (median survival 10.04 years, adjusted hazard ratio
(HR) = 1.19, 95% con?dence interval (CI) = 1.14-1.23),
mastectomy with radiation (median survival 10.02 years,
HR = 1.20, 95% CI = 1.14-1.27), and BCS without radi-
ation (median survival 7.63 years, HR = 1.81, 95% CI =
1.70-1.92). Among women representative of those eligible
for clinical trials (age B70 years, Charlson comorbidity
score = 0/1, and stage 1 tumors), there were no differences
in survival for women who underwent BCS with radiation or
mastectomy. In conclusion, after careful adjustment for
differences in patient, physician, and hospital characteristics,
we found better survival for BCS with radiation versus
mastectomy among older early-stage breast cancer patients,
with no difference in survival for BCS with radiation versus
mastectomy among women representative of those in clini-
cal trials. These ?ndings are reassuring in light of recent
trends towards more aggressive primary breast cancer therapy.
http://tinyurl.com/22klh2t
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