‘Lumpectomy’ Called Safe as Mastectomy : New Breast Cancer Study Supports Less Disfiguring Procedure
Treatment of early breast cancer by a “lumpectomy”--surgery that removes the malignant tumor and surrounding tissue--combined with radiation therapy is as effective as total removal of the breast, the far more disfiguring procedure practiced for decades, a major new study released Wednesday concluded.
“We know early detection of breast cancer can save a woman’s life,” Health and Human Services Secretary Margaret M. Heckler declared in a statement. “Now it can also minimize her disfiguration and aid her recovery.”
The study, sponsored by the National Cancer Institute and conducted by an international group of more than 500 physicians, called lumpectomy “appropriate” for improving the survival rate of breast cancer patients with tumors 1 1/2 inches or less in diameter--a finding that could affect as many as half of the 119,000 American women who contract breast cancer every year, the researchers said.
About 1 in 11 American women develop breast cancer sometime during their lives. Currently, only about 15% of all breast cancer cases are treated by procedures less than total breast removal, the study said.
The study followed its patients for an average of 39 months but said the five-year survival rates--a projection based on a statistical method called “life-table analysis”--showed women with lumpectomies to be in no greater danger than those who had undergone total mastectomies.
But Dr. Bernard Fisher, professor of surgery at the University of Pittsburgh School of Medicine who led the study, stressed the importance of monitoring and long-term follow-up “because breast cancer is a chronic disease that can recur many years after the initial tumor is found.”
He added: “Not every woman is a candidate for lumpectomy. It would be a disservice to say to them: Don’t let a doctor take your breast.” He said therapy would depend not only on tumor size but also on other factors, including tumor location, whether the patient could tolerate radiation and her psychological profile.
Dr. William C. Wood, chief of the Massachusetts General Hospital Cancer Center in Boston, cautioned that much more follow-up research is necessary before anyone knows if women with lumpectomies will survive as long as those with mastectomies. And an editorial published in the New England Journal of Medicine cautioned that the study is not the final word on the subject.
‘Treatment of Choice’
Nevertheless, Dr. Vincent T. DeVita Jr., director of the National Cancer Institute, called the findings--published in today’s issue of the New England Journal of Medicine--”powerful indicators that less surgery can be just as good as more surgery for many women.” For those who meet the criteria, DeVita said, lumpectomy could be “the treatment of choice.”
Earlier studies had reached similar conclusions about the value of alternatives to mastectomies, but were not as definitive as the new National Cancer Institute report, the journal article said.
The latest study, part of a $5.5-million project by the institute, is an outgrowth of an earlier trial begun in 1971 that compared treatment with radical mastectomy--removal of the breast, lymph nodes and underlying muscle--with total mastectomy, or removal of the breast alone.
The newest trial of the National Surgical Adjuvant Breast Project, begun in 1976, involved 1,843 women in 89 medical institutions who were given one of three treatments: total mastectomy, lumpectomy--also known as segmental mastectomy--or lumpectomy followed by five weeks of cobalt radiation.
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“These two studies present scientific data that support the trends away from the mutilating, debilitating Halsted radical mastectomy that was standard treatment for almost a century and toward breast-preserving surgical techniques,” Fisher said. “We have abandoned conventional concepts of breast cancer surgery. . . .”
The study projected a 28% cancer recurrence rate in the breast tissue in the group receiving lumpectomies alone, contrasted with an 8% recurrence rate in the group receiving lumpectomies and radiation.
“We think we can improve on this 8%,” Fisher said. “We think the cancer can be managed at that time.” He said he believed a woman’s survival prospects would be no less than if she had received a total mastectomy and “she would have had her breast” that much longer.
Higher Survival Rate
The projected five-year survival rate was about 85% for women who had lumpectomies, including radiation, and 75% for those who had mastectomies, a difference Fisher said was not statistically significant.
The study also found that radiation significantly reduced the chances of recurrence after a lumpectomy. A total of 92.3% of patients who received radiation after a lumpectomy were projected to remain disease-free after five years, contrasted with 72.1% of those who received a lumpectomy without radiation.
In all three groups of women, the underarm lymph nodes were removed to determine whether cancer cells had spread there. If they were cancerous, Fisher said, the women also received chemotherapy. The study also found that in patients with cancerous lymph nodes, 97.9% of those receiving radiation and 63.8% of those without radiation remained tumor-free, although both were given the same chemotherapy.
