Women who are diagnosed with breast cancer are faced with decisions about their treatment. Two new studies, published in the Annals of Oncology and presented at the ESMO 2012 Congress in Vienna, Austria suggest women may not be offered the option of breast conserving treatment – surgery to remove just the cancer, but saves the breast.
According to the European Society for Medical Oncology findings, chemotherapy and radiation treatments can completely eradicate tumors, but many women still undergo mastectomy. The study authors say breast removal for cancer may not be justified. The study raises concern that perhaps women aren’t being given that option.
Despite the fact that their investigation from the NeoALTTO trial showed a combination of the chemotherapy drugs paclitaxel, lapatinib and trastuzumab doubled the response rate of breast cancer treatment, only 40% of women received breast conserving treatment.
Dr Carmen Criscitiello from the European Institute of Oncology in Milan, Italy said in a press release, “Indeed, we saw that tumor characteristics prior to neoadjuvant therapy play a main role in deciding the type of surgery, irrespective of the response to given therapies.”
“This study highlights a negative attitude that may deny a large fraction of women the chance of preserving their breast, with no clinical reasons that justify this decision, Criscitiello said.
“One of the goals of the neoadjuvant therapy concerns increasing the rate of breast conservation, but this goal is clearly not achieved if the type of surgery is chosen according to baseline characteristics.”
In other words, said Prof Michael Gnant, a surgical oncologist from Vienna’s Medical University, who was not involved in the studies, don’t make decisions about breast removal or mastectomy until after treatment, in a commentary to the finding.
“I agree that modern breast cancer surgery should orientate its strategy according to the post-treatment outcome rather than the baseline situation. When this is implemented in more centres (as some –including ours– already have), even more women will benefit from the advances in multimodality treatment.”
British researchers pointed out at the conference that early stage breast cancer can be treated with chemotherapy and radiation without destroying breast appearance.
But even though the new study suggests breast cancer may not always mean the need mastectomy, there is a flip side for women.
A British study published July, 2012 found 1 in 5 women who don’t opt for mastectomy need a second surgery that can lead to anxiety and more healthcare costs.
According to a Los Angeles Times report by Thomas H. Maugh II, “The need for a reoperation was most common for women with ductal carcinoma in situ, a form of cancer whose edges are very difficult to define for removal of the tumor.”
Prof Gnant noted in a media release: “While concomitant radiotherapy and chemotherapy is contradictory to most institutions’ current standards, it is apparently feasible without additional harm.”
The researchers are asking for a clear understanding that breast conserving treatment should be offered to women whose breast cancer responds to chemotherapy. “This will translate the progress in neoadjuvant therapies and the consequent high pathological complete response rates into higher rates of breast conservation”, say the authors. For women with cancer, keeping your breast might also mean more surgery in the future. Discuss your options thoroughly with your physician.
Source: ESMO News
Ann Oncol (2012) 23 (10): 2591-2598.
Ann Oncol (2012) 23 (4): 876-881.
National Cancer Institute
Breast Conserving Surgery