Early BC Survival Better After Lumpectomy than MX

Thanks for posting! Results should help those making decisions down the road.

http://www.medscape.com/viewarticle/778276

"The unmeasured variables include the use of adjuvant systemic therapy, she explained. "Advances in systemic therapy are credited for a large part of the reduction in mortality from breast cancer we've seen in the past 2 decades."

The absence of data on systemic therapy was especially concerning to another expert.

"We know that systemic therapy has a large influence on overall and disease-specific survival,' said Maurice van der Sangen, MD, a radiation oncologist from Carina Hospital in Eindhoven, the Netherlands, who has studied breast cancer recurrence."

And "...more women in the mastectomy group than in the BCT group were treated before 1999 (59% vs 48%), when systemic therapy was used only in the case of node-positive disease, said Dr. van der Sangen."

How in the world could they do this research and leave out the chemo factor?       Deanna

This was in the daily mail today and I looked at it and thought, good news. Then I read it was for early stage 1 and 2 so it doesn't help me.



I don't tell people I had an Lumpectomy because I get funny looks, they think I've made the wrong choice. I was even thinking about more surgery only because I was made to feel I did the wrong thing.

disclosure: I had a mastectomy.

My BS told me that survival with lumpectomy + rads was about identical to mastectomy. 

Frankly, I think a lot of these treatment decisions go in phases.  It seems to me that a lot of people are currently getting BMX.  I suspect we might see a shift, with studies like this, to less invasive surgery (i.e., lumpectomy+rads) where possible.  True, there are a lot of co-variates not considered here, but they don't make the trend seen in the study not true.

It all comes down to what one is comfortable doing. No one should have to defend her decision, since she is the only one living with it.

I am not quite sure why this is such big news, I think there was a very large study that showed something similar about a year ago.

I think all it really shows is that radiation has a benefit, perhaps a slightly greater benefit than a mast.

Obvioulsy everyone is not a candidate for a lumpectomy, but in terms of dying from cancer, it is a safe option.

I belive local recurrances are still higher with a lump.

http://www.cbsnews.com/8301-505263_162-57566151/less-is-more-new-study-indicates-less-invasive-treatment-may-yield-better-results-for-breast-cancer-patients/

Jenrio, AMEN! Bring on the cure!

When I choose a pink hat over another hat with different shade of pink, I have a CHOICE A.

When a prisoner is fortunate to be able to choose 1 out of  2 tortures, he has a CHOICE B.

When a young mother dxed with highly aggressive breast cancer during pregnancy, she have a CHOICE of lumpectomy vs mastectomy vs chemo vs wait fullterm vs preterm delivery.    But is it more like the CHOICE of my pink hat or more like the CHOICE of prisoner's torture?

Until there's a cure for highly aggressive late stager breast cancer with metastasis to brain/liver,  all this time and billions to work on so many aweful and equivalent choices none of which is a guaranteed cure, and none of which will EVER be a guaranteed cure, because they are all dead-ends based on 50+ year old technologies/knowledge.    

Yes, we all want a cure.  But a cure for what?  Breast cancer isn't one disease, it's dozens of different diseases.  IDC or ILC?  Mucinous or tubular or papillary or medullary or NOS? ER+ or ER-?  HER2+ or HER2-? Luminal A or Luminal B?  Etc. etc., etc.........

If we are lucky, a cure will be developed for some of these types of breast cancer.  If we are even luckier, genetics will lead us to find a way to target and treat the very specific diagnoses of each individual. And if we are luckier still, one day there will be discovery (more likely a way to treat vs. a specific treatment) that is able to cure everyone diagnosed with any type of breast cancer. But when is that going to happen? Progress is being made; I was diagnosed more than 7 years ago and I follow the research very closely. We certainly know a lot more about breast cancer now, and there are many more targeted treatment trials underway, than 7 years ago. But as I see it, we are still a long way from having an overall cure. 

And what's with wanting a cure anyway? Don't we actually want prevention? We won't need a cure if there is a way that we can prevent the diagnosis from ever happening. But unfortunately I think we are even further away from that. 

I am optimistic that a lot of process will continue to be made and that in the future our daughters and nieces will have different, better, more targeted treatment options than we do. Maybe our granddaughters will have a cure. But I don't expect a cure anytime soon, and it's not for lack of trying. So for now, I'm happy when research comes out that helps us today with the treatment choices we have to make when we are diagnosed.  That's because the newly diagnosed women joining this board every day weren't diagnosed in the future, they are diagnosed today.  

So Jenrio, while I share your desire for a cure, I really don't agree with you on this. The way I see it, until we reach the future, anything that makes the present better or easier to deal with is a good thing.

ali, I think what your doctor was saying is that with a node positive Stage III cancer that is grade 3, your primary concern is not the cancer in your breast, but ensuring that you have whatever treatments are necessary to attack and kill off any cancer cells that might have already moved beyond your breast. 

Breast cancer in the breast is actually not harmful. As vital as our breasts may be to many of us, they are not vital to our survival. So cancer cells that are confined to a breast do not put us in danger. The harm from breast cancer comes when some of those breast cancer cells move beyond the breast, either through the bloodstream or the lymphatic system, and take hold in other part of the body - the bones or a vital organ.  With your Stage III node positive diagnosis, the risk that this might have happened is higher, so for you the critical treatment is chemo. The goal of chemo is to track down any breast cancer cells that might be in the body, and kill those cells off before they have the opportunity to embed themselves and take hold.

Having a mastectomy, i.e. removing the whole breast, wouldn't have any impact on what's happening in the rest of the body beyond the breast.  And because it's a more major surgery than a lumpectomy, it could put more strain on your body. With the positive nodes, I'm guessing that you would have needed rads whether you had a lumpectomy or mastectomy, so that one benefit of a mastectomy wouldn't be a factor for you. I think that's why your surgeon wanted you to focus on chemo rather than a more major breast surgery.

If I listened to the video (and read the abstract) correctly, they are looking at the first 3 years.

Those of us past 3 years...does this mean this issue is moot?

And how I hate the nuances of greater than or equal to 50 years old.  So I was 49 at dx and had lumpectomy within a week of turning 50...then had bmx in June, so I was  at least equal to 50....ugh....who falls into what category.

I think the study is affirming that lumpectomy PLUS rads is equal to mastectomy.  And yes, this gives women a choice.  My doctors did not like my choice but let me proceed as I wished.

Prevention is good.   But would I be happily paying $xxxxx, suffering major surgeries surgery,  chemo with my baby inside, bringing my baby out preterm to save my own life,  for about 15% absolute risk reduction?   

Is the taxpayer happy paying $Billions, giving 40 yo women annual mammograms (radiate them every year for 30 years yay), surgeries for xxxxxx a year, chemo for xxxxx a year, and still having 50k a year dying (about the same as 20 years ago)?

Women constantly worrying about their decisions, did my baby or lack of baby or too early/too late baby cause my cancer?   did my stress give me cancer?   did my second-hand smoking/drinking/candy fix give me cancer?  did my overweight/underweight give me cancer or metastatic cancer?   Did my lumpectomy+RAD or mastectomy give me metastatic spread?

Maybe, maybe not.   When there's a CURE, no body would care.   People don't deserve to die before their time because of any of above decisions.    In our civilized country, a hardcore criminal is less likely to die in our death row than a young BC patient dxed with triple negative cancer.    

Prevention is good but is leaky.   To make it a foolproof guarantee, you need a huge investment and possibly never ending investment.     Cure for metastatic cancer is possibly much cheaper and all our increasing knowledge helps us in the right direction.     So go for the cure, and not be distracted by any thing short of a cure.

Wallycat,

Are you saying "asking for the cure not prevention" too trivial or pointless in this forum?

The researchers know and I am hopeful that there will be cures.   But NIH budget should NOT be cut, NCI budget should NOT be cut, even Komen's budget for the CURE should NOT be cut.

But the mammograms, expensive breast MRIs, endless studies that draws no valid conclusions and is never likely to draw valid conclusions and merely exists to give women "choice".   They should be reviewed and budget may be cut.

And women need to learn to ignore these studies and do whatever they wants knowing that most of these "choices" make no difference, and should NOT make any difference.   They have a right to life and their money needs to go for research and the cure, not prevention or other expensive learn-nothing and do-nothing studies. 

Either I fail to communicate or you fail to understand my message.     

I certainly don't appreciate words like "beg" "over and over" "blame" you are using to *describe* my message or my method of delivery.   I forgive you however because this is a public forum and it's impossible to be clear and please everybody and make everybody feel they are a winner with all the best "choices".

Duh, I feel like a loser myself with my crappy choices.