Breast-Saving Urged for More Cancer Victims : Medicine: Three major health organizations cite benefits in options less-radical than mastectomies.

At least one-third and possibly half of women diagnosed with early-stage breast cancer could be candidates for breast-saving “lumpectomies” rather than breast removal but not enough doctors are offering that option to their patients, three major health organizations said Monday.

The three organizations--the American Cancer Society, the American College of Surgeons and the American College of Radiology--urged physicians to discuss breast-saving therapies with patients and released a set of guidelines describing which types of patients would be likely candidates.

Experts have recognized in recent years that the mastectomy--surgical removal of the entire breast--and the lumpectomy--removal of the tumor followed by radiation therapy to kill any remaining cancer cells--produce nearly identical survival rates.

Dr. James Cox, chairman of the commission on radiation oncology for the American College of Radiology, said that at least one-third of all breast cancer patients would be eligible for the less severe lumpectomy and “that number might be as high as half of all breast cancer patients today because mammography is detecting breast cancers earlier.”

Breast cancer is the most frequently occurring cancer in women and the second leading cause of cancer deaths in women after lung cancer. An estimated one in nine women can expect to develop breast cancer in her lifetime.

An estimated 180,000 new cases of breast cancer will be diagnosed in this country in 1992 and approximately 46,000 women already diagnosed will die.

“Breast cancer is one of a number of areas where organ-sparing procedures are coming into their own,” said Dr. Sam Broder, director of the National Cancer Institute, when asked for his reaction to the recommendations.

“Treatment is an individual choice and doctors have to make women understand what all the options are and what their side effects are,” Broder added. “And what is also very clear is that no woman should feel that her point of view is irrelevant.”

For many years, the standard treatment for breast cancer was mastectomy. Both surgical procedures are considered “primary” treatment and follow-up therapy using hormones or chemotherapy to kill cancer cells that may have spread to other parts of the body also may be necessary, the experts emphasized.

Most women, whose early breast cancer is detected by mammography, and women with a small lump whose cancer has not spread to surrounding tissues are candidates for the breast-sparing treatment, the groups said. Also, depending on the size of the tumor compared to the size of the breast, women whose cancer may have spread also could be candidates, they said.

The groups’ recommendation was prompted in part by a study released earlier this year showing that breast-cancer treatments varied widely depending on where a woman lives.

For example, many more women receive breast-conserving therapy on the West Coast or in New England than in the East South Central region--Kentucky, Tennessee, Mississippi and Alabama--or the West North Central area, including Minnesota, North and South Dakota, Iowa, Nebraska, Kansas and Missouri, the Cancer Society said.

The information came from an analysis of data from the National Cancer Data Base of more than 41,000 women treated in 1988, nearly one-third of all the patients treated for breast cancer in the United States that year.

Cost is another important factor in favor of the less radical procedure, the organizations said. They cited a study of patients treated at UCLA Medical Center published earlier this year which showed that total charges for a modified radical mastectomy and breast reconstruction were 31% higher than for lumpectomy and radiation therapy. The study said that the differences stemmed from the expense of a longer more complex hospitalization and anesthesia.

The groups also cited at least seven major studies comparing mastectomy versus lumpectomy/radiation in women with early breast cancer, defined by primary tumors of less than four or five centimeters, with no spread to lymph nodes or distant sites in the body. “Overall survival and relapse-free survival . . . were not statistically different in any of the trials,” they said.

Not everyone with early breast cancer is an ideal candidate for breast-conserving treatment, however. For a woman with small breasts, for example, the procedure could produce a cosmetically unattractive result. Some women also might be eager to complete their primary treatment as quickly as possible, decide they do not want to spend six weeks undergoing radiation.

“Each woman must evaluate how her choice of treatment is likely to affect her sense of disease control, self-esteem, sexuality, physical functioning, and overall quality of life,” said Dr. David Winchester, medical director of the cancer department for the American College of Surgeons.