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

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Anonymous Member Posts: 1,376
Lx + Rx Offers Better Survival Rates Than Mx for Early BC

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  • Moderators
    Moderators Member Posts: 25,912
    edited May 2021

    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...

  • dlr68
    dlr68 Member Posts: 11
    edited May 2021

    So does this mean that women with early stage breast cancer who have mastectomies have poorer survival rates than women who have had lumpectomies...given that all other “major" factors were accounted for? I know all about how every person's cancer is different and you need to discuss all options with your care team, etc., etc., but this study makes me feel like I just did myself in for having double mastectomies..one breast with cancer and other breast was removed for prophylaxis. What makes a mastectomy more detrimental to overall survival than lumpectomy?

  • moth
    moth Member Posts: 4,800
    edited May 2021

    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

  • dlr68
    dlr68 Member Posts: 11
    edited May 2021

    Thank you for your reply and insight. I just find myself throwing my hands up so often.

  • FarAwayToo
    FarAwayToo Member Posts: 255
    edited May 2021

    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.

    image

    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.



  • Rah2464
    Rah2464 Member Posts: 1,647
    edited May 2021

    Thanks for doing the deeper dive, FarAway. It was on my list of things to look at but I hadn't gotten there. I agree it doesn't make sense to include such a large population who didn't have radiation therapy when nodal involvement was present. Perhaps it should have been presented both ways.

  • mightlybird01
    mightlybird01 Member Posts: 217
    edited May 2021

    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.


  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    FarAwayToo—adding my thanks as well. Everything about this headline raised questions in my mind but I wouldn’t have been able to deep dive like you did. Although lumpectomy and radiation can be effective, mastectomy is a very viable option and women need careful guidance for their personal situation to make the right choice. When you are facing BC for the first time, it’s this type of headline that can stop you from asking all the questions you don’t know enough to ask

  • mightlybird01
    mightlybird01 Member Posts: 217
    edited May 2021

    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.

  • ctmbsikia
    ctmbsikia Member Posts: 1,095
    edited May 2021

    I admire so many of you for your wealth of knowledge and understanding when all this information is brought forward.

    I whole heartedly agree it is a very individual decision. At the time of my diagnosis I was also told same survival rate MX vs. LX. + rads. One factor that weighed in my mind was since I was not a candidate for a double MX, just a single, and having larger breasts, it was too difficult for me to dive further into seeing a PS or picture myself living with one big breast and nothing on the other side. Plus the longer and more radical surgery is why I chose LX + rads. I don't have any regrets really, but having a 4cm tumor, there's a lot missing. I'm obviously uneven, and I've also had some post surgical issues. I was unaware at the time of my decision that surgery and radiation would have long lasting affects. I'm OK though, other than imaging time. Scanxiety is real. Happy for those of you that no longer have to do it. At diagnosis, I never thought of that! But still would have had to do imaging on the right one. Still no regrets.

  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited May 2021

    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
    FarAwayToo Member Posts: 255
    edited May 2021

    Mightlybird, yes the black curve is for lumpectomy + radiation and orange-ish red for mastectomy with radiation.

    Throughout all the groups the lumpectomy + radiation came out to the best survival, but in most it was so close to the mastectomy (whether with or without rads) that I don't think the differences are convincing. It's only when lots of nodes were involved the mastectomy without rads was obviously inferior to lumpectomy with rads. And for the same group with 4 or more nodes involved the survival didn't really differ between mastectomy WITH rads and lumpectomy with rads.


    And yes, surgery decisions are hard. For me, personally, I was all for lumpectomy, so that I could avoid bigger surgery. That was when we only knew about invasive cancer on the right. Once I had an MRI, the multicentric DCIS was found on the left, and my surgeon conveyed that doing a lumpectomy on the left would be difficult, as both DCIS areas were pretty large and far away from each other. With that, it didn't make sense to do mastectomy on the non invasive side, lumpectomy on invasive, and still do radiation. Clinically, my nodes were clear, and stayed that way at surgery. So I had mastectomy without radiation. I feel it was the right choice in my case. Had I not had DCIS on the left, I would probably choose lumpectomy.

  • cake8icing
    cake8icing Member Posts: 58
    edited May 2021

    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.

  • cake8icing
    cake8icing Member Posts: 58
    edited May 2021

    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.

  • moth
    moth Member Posts: 4,800
    edited May 2021

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

  • moth
    moth Member Posts: 4,800
    edited May 2021

    When you look at the HRs the data is clear

    Lx+rt had better outcomes.

    We need this type of info . That's how progress happens. As more studies and datapoints accumulate, we will develop better treatment plans.

    Does it throw some of our decisions in doubt? Sure. That's the reality of cancer. Some of us find that our treatment plans were wrong or a chemo regimen gets discredited. Tons of women took Avastin for breast cancer and then it was withdrawn. It was approved for metaatatic breast cancer in the USA for 3 years. People on this board used it. And then we got new data. That's how it goes.

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    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.

  • moth
    moth Member Posts: 4,800
    edited May 2021

    hopeful, not sure we can compare these as the JAMA is about DCIS & the BMJ is about IDC. but even so

    1. that JAMA study specifically says they did not find a significant mortality difference between the treatment groups.

    Ie this study found surgery choice made no difference for overall survival or breast cancer specific survival. OS and BSS are the issues the BMJ study is addressing.


    2. It did find greater risk of ipsilateral recurrence which makes sense since obviously less tissue remains after a mastectomy

    3. IDC and dcis are quite different from a surgical standpoint. I know some surgeons say that dcis can be very difficult to visualize and thus to obtain good margins so mastectomy is often required

  • Ibis
    Ibis Member Posts: 71
    edited May 2021

    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.


  • Rah2464
    Rah2464 Member Posts: 1,647
    edited May 2021

    Moth I appreciate your comment about treatment information and paths changing. You are so correct and we do need to talk about new data that becomes available. This is wonderful dialogue for all of us and I so appreciate you bringing it here, as well as you and others that are doing a deeper dive into the data to understand it better.

  • Moderators
    Moderators Member Posts: 25,912
    edited May 2021

    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

  • Jetcat
    Jetcat Member Posts: 64
    edited May 2021

    Thank you Mods! I realize the first study was early cancer, not DCIS specific. I tend to focus on DCIS —it’s great that more studies and data are being published regarding DCIS because so many women are being diagnosed with it now and it has such a wide array of characteristics. I hope some day they will be able to more specifically predict which cases will progress to invasive, etc

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