New Research Presented at the 5th Annual Breast Cancer Symposium
Co-sponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, the American Society of Clinical Oncology, the American Society for Radiation Oncology, the National Consortium of Breast Centers, and the Society of Surgical Oncology
New studies on breast cancer screening, treatment, and survival were presented at the 2011 Breast Cancer Symposium held September 8-10, 2011, in San Francisco, California.
Two Studies Report Similar Recurrence,
Survival Rates for Breast
Conservation and Mastectomy Among
Younger Women with Breast Cancer
A pair of studies indicates comparable outcomes – in local recurrence and survival rates – for lumpectomy or mastectomy among women with breast cancer age 40 and younger. Young age at diagnosis is considered a risk factor for breast cancer recurrence, and there has been a trend in recent years among young women to increasingly choose mastectomy rather than lumpectomy – despite a lack of definitive evidence showing improved survival. As a result, these findings may have important implications in treatment decisions.
Study Finds Recurrence Rates
Are Similar in Younger Women Who
Have Either Breast Conservation
Surgery or Mastectomy
In this retrospective study, Julliette Buckley, MD, a fellow in breast surgery at Massachusetts General Hospital, and colleagues reviewed medical records of 628 women age 40 and younger who were diagnosed with up to stage III breast cancer. They examined various patient demographic data and determined rates of local recurrence, distant recurrence, and overall survival. When they analyzed the data according to the type of surgery the women had, they found no statistically significant difference in local cancer recurrence risk.
“Although the majority of women in our study underwent breast-conserving therapy, previous research has suggested that this procedure leaves women at greater risk for local recurrence. However, we found no significant difference in the rates of local recurrence between women treated with breast-conserving surgery or mastectomy. These results suggest that advances in chemotherapy, imaging, and radiation have reduced local and distant recurrence risks and have made breast-conserving therapy a safe option for many young women,” said Dr. Buckley.
Analysis Shows Breast Conservation
and Mastectomy Result in Similar
Survival Among Younger Women
with Early-Stage Breast Cancer
Investigators led by Usama Mahmood, MD, a fellow in radiation oncology at The University of Texas MD Anderson Cancer Center, compared overall survival and breast cancer-specific survival among women ages 20 to 39 who were diagnosed with early-stage breast cancer. Of these women, 45 percent received breast conservation therapy and 55 percent underwent mastectomy. After accounting for a number of variables, they found no difference in overall and cancer-specific survival between the two groups.
“Our findings provide reassurance that breast conservation therapy leads to similar survival outcomes as mastectomy even in younger women with early-stage breast cancer,” said Dr. Mahmood. “These findings can provide reassurance to younger women with early-stage breast cancer who are considering less aggressive surgery.”
New Statistical Tool May Predict
Risk of Lymphedema Associated
with Breast Cancer Surgery
Researchers have created a set of statistical models that are more than 70 percent accurate for predicting the fiveyear risk of developing lymphedema after lymph node removal during breast cancer surgery. While the models continue to be refined, they could eventually become a useful decision-making tool for physicians. These findings have important implications because it is currently very difficult to predict which women will develop this surgical side effect.
In women with breast cancer, lymphedema is a swelling under the arm characterized by localized fluid retention and tissue swelling that can occur following axillary lymph node surgery, which is often necessary if the cancer has spread to the lymph nodes. It can be a chronic, disabling condition, and it affects about one-third of those who have axillary lymph node surgery.
Investigators led by Jose Bevilacqua, MD, phd, a surgical oncologist at Hospital Sirio Libanes in Sao Paulo, Brazil, prospectively studied about 1,000 women with breast cancer undergoing axillary dissection. The overall five-year incidence of lymphedema in the group was 30.3 percent.
Using a variety of clinical factors, the researchers developed three models to predict the risk of developing lymphedema at different points in time following surgery. The researchers compared the models’ predictions to the actual occurrence of lymphedema in this group of women and found that the models correctly predicted a person would develop lymphedema more than 7 out of 10 times.
“These models performed well,” Dr. Bevilacqua said. “The statistical models […] use readily available clinical factors and allow for quick and easy estimation of individual risks of developing lymphedema after axillary lymph node surgery in women with breast cancer. For the sake of comparison, these modeling tools are as accurate for predicting a woman’s risk of developing lymphedema as mammography is for the detection of breast cancer.” Dr. Bevilacqua suggested that the models may become useful tools to help physicians choose whether to recommend axillary dissection.
Additional Studies of Note
Impact of Chemotherapy Timing
on Local-Regional Failures in Women
Undergoing Breast-Conserving Therapy
“Traditionally, surgery has been performed prior to chemotherapy in women with large breast cancers. This study demonstrated that in women undergoing chemotherapy first, the risk of local recurrence was the same as in women undergoing surgery first. Administering chemotherapy first may allow for ‘downstaging’ or a significant decrease in the size of the cancer prior to surgery. There is no adverse effect on recurrence rates. While this study did not address cosmesis, decreasing the size of the tumor prior to surgery may allow for a more cosmetically acceptable lumpectomy to be performed.” – Deanna Attai, MD, Center for Breast Care, Inc.
Relationship Between Taxane-Induced
Neuropathy and Clinical Outcomes after
“As components of adjuvant chemotherapy, taxanes improve relapse-free and overall survival. Their use can be limited by peripheral neuropathy. Prior work has demonstrated the potential for single nucleotide polymorphisms (SNPs) to predict for taxane neurotoxicity. The current analysis […] provides reassurance that taxane neuropathy is not linked to taxane benefit.” – Andrew D. Seidman, MD, attending physician for the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center
Male Breast Cancer: Survival Rate
and Determinants of Prognosis
“While the study itself has some limitations, the authors confirm what has been shown historically. Breast cancer in men occurs later in life, is frequently associated with a delay in diagnosis, and is commonly associated with lymph node involvement. Although breast cancer is rare in men, these findings demonstrate that it is critically important to continue to raise awareness about the occurrence of breast cancer in men.” – Gail S. Lebovic, MA, MD, FACS, past president of the American Society of Breast Disease
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This article was published in Coping® with Cancer magazine, September/October 2011.