Lx + Rx Offers Better Survival Rates Than Mx for Early BC

Lumpectomy Plus Radiation Offers Better Survival Rates Than Mastectomy for Early-Stage Breast Cancer
May 18, 2021
Lumpectomy plus radiation therapy offers better survival rates than mastectomy — with or without radiation — for women who are diagnosed with early-stage breast cancer. Read more...

Yes, that's what this study found.

we don't know why it's riskier but one theory I've heard is that breast tissue is part of the immune system. So is the uterus, btw.

I think we all make the best decisions we can with the evidence we have - no point in regrets over things which are done

I read the entire study, not just the synopsis on BCO. What stood out to me is that they had women with T1N2 and T2N2 tumors (4 or more lymph nodes positive) treated with mastectomy and no radiation. I am a data geek and wanted to see if this subgroup contributed to the lower survival among those with mastectomy.

Looks like it did. Take a look at the image below. Light blue line is for the MX-RT (mastectomy, no radiation) group. You can see that for all but TXN2 tumors the survival curves are very close for all treatment types.

Here is what the study says:

"Locoregional treatment not following national guidelines (ie, no RT after mastectomy despite nodal involvement) occurred in 2542 women (5.2%)". This is a pretty big proportion, to be honest.

Honestly, I would not base my own decision to have either of the surgeries on this particular study, because it seems like a lot of data noise from the women who didn't have radiation despite multiple positive nodes. They should have excluded them from the study, and results might have been a bit different.

Thank you for those plots FarAwayToo! This is striking. Is the red curve the one for MX with radiation and the black for lumpectomy with radiation? It is hard to see as one can't magnify that plot.

I agree, it is a very individual decision. In my case (small A breasts), my Drs. always said mastectomy had the same effect as LX + Rads, but for some reason I had the impression that they were advising me to do the mastectomy. I read between the lines, as they never stated which one I should do, and I did not push them to decide for me, but all through I felt I had a very strong support for MX and no radiation for me (as I was node negative). Maybe this is just because I had such small breasts that LX+Rad would have basically be quite similar to MX. I never pushed them to give me their reasoning, but I had really good support for my decision, MX, no radiation, no reconstruction. And honestly, I am very happy with my decision, as it means no more screening on that cancer breast. I am glad I still have one healthy breast though, so prophylactic double mastectomy (BRCA negative) would not be an option for me.

I don't think this post is helpful at all for the newly diagnosed. Thank goodness and much appreciation to those of you for being to dig deep and also to point out that the newly diagnosed don't know the questions to ask. Sorry for my negativity.

FarAwayToo: you hit exactly what I was thinking about the synopsis and thank you for going to the original article. I felt like so much was missing from the synopsis, like, post mastectomy, what did the pathology report say? I had stage 0 but my BC was very specific with me that there was a 20% chance of micro invasion into the tissue which would mean post-surgical treatment after my mastectomy. I was lucky that the pathology came back all clear, but I was mentally prepared for further treatment if necessary. I have to say, there is a part of me that reads this article and thinks, are healthcare providers trying to scare women into lumpectomy and radiation and drug treatment because it brings in more income than a simple mastectomy? Sorry if that sounds conspiratorial, but one does wonder.

mastectomy and reconstruction brings in way more $ for surgeons if we're considering financial aspects

Hi Moth- I absolutely agree that more and better data can and will lead to progress. This is from a recent US based study— this indicates a slightly better advantage fir mastectomy. I’m absolutely not advocating for one or the other—just advising that it’s so hard, being confronted with a first incidence of cancer, to make fully informed decisions. In My first DCIS diagnosis, lx with Radiation was strongly advocated. It would have been a perfect choice if DCIS hadn’t been found again less than 2 years later. I don’t regret or blame anyone for my experience—-I just want to be sure that anyone with BC gets help with decisions

Long-term outcomes for women with and without DCIS have been limited, until now

A recent study published in The BMJ offers the best data so far on the risks associated with DCIS and the impact of different treatments. In the study, more than 35,000 women diagnosed with DCIS via mammography were followed for up to 20 years to see if they developed invasive breast cancer or died of breast cancer.

Overall, the researchers found that having DCIS more than doubled the risk of developing invasive breast cancer and increased the risk of dying of breast cancer by 70%, compared with the general population. Moreover, the researchers observed that more intensive treatment of DCIS was associated with lower risk of invasive breast cancer. Compared to women who had both breast-conserving surgery (lumpectomy) and radiation therapy, those who had lumpectomy alone had 43% higher rates of breast cancer, and those who had mastectomy had 45% lower rates of breast cancer. A larger DCIS-free margin in the biopsy sample was also associated with lower rates of developing invasive breast cancer. For women with estrogen receptor-positive DCIS, hormone treatment to reduce estrogen levels was associated with lower risk of invasive breast cancer.

The findings from this new study are broadly similar to a US study of more than 100,000 women with DCIS that found an 80% higher risk of dying of breast cancer in women with DCIS than in the general population, although that study couldn't determine how the DCIS was diagnosed. A Danish study also found that women with DCIS who were treated with mastectomy had lower rates of invasive breast cancer in that breast than those treated with more conservative surgery, with or without radiation therapy.

No regrets or second guessing about having 2 mastectomies for DCIS. First time, 2 breast surgeons recommended MX because of the size of the DCIS. A year later, the other breast had a small area of DCIS and I decided on another MX. No radiation or anti estrogen meds. I haven't researched the above study, but I know 2 MXs (with reconstruction) were the best decisions for me.

Hi all, we've been following your discussion here and wanted to address your concerns.

First, we know that everyone's situation is unique. Breastcancer.org presents summaries of the latest research and encourages everyone to talk to their doctor about how the results affect their individual situation. Please note the following from the research news article:

What this means for you

If you've been diagnosed with early-stage breast cancer, you and your doctors will talk about a surgical approach that makes the most sense for you and your unique situation. You may consider a number of factors, including:

• the characteristics of the breast cancer
• your age
• any other health conditions you might have
• your preferences
• how close you are to treatment facilities
• your personal risk of recurrence and your concern about the cancer coming back
• your reconstruction options and preferences

At Breastcancer.org, we support everyone's right to make treatment decisions based on the characteristics of the cancer they've been diagnosed with, their medical history, their risk of recurrence or a new breast cancer, and their personal preferences. But it's very important to make sure you understand all the pros and cons of any treatment or procedure you're considering, including differences in survival rates.

We hope this helps clear things up, and please don't hesitate to reach out to us about with any other questions or concerns!

--The Mods