Radiation therapy after a lumpectomy reduces the risk of cancer recurrence and improves survival in women with early stage breast cancer, according to a new study, and experts say this research helps validate their belief that women in the early stages of the disease don't have to lose their breasts.
The study, published this week in the Lancet, is an analysis of 17 different worldwide trials looking at the effects of radiation after a lumpectomy. The research, done by the Early Breast Cancer Trialists' Collaborative Group, an organization of hundreds of scientists from around the world who study breast cancer treatments, evaluated data from more than 10,000 women with breast cancer for an average of 10 years.
The authors found that 19 percent of women who had radiation therapy had a recurrence compared to 35 percent of women who didn't. Women who had radiation were also at lower risk of dying 15 years after diagnosis compared to women who didn't have radiation.
"The overall findings from these trials show that radiotherapy after breast-conserving surgery not only substantially reduces the risk of recurrence but also moderately reduces the risk of death from breast cancer," the authors wrote.
Breast cancer specialists not involved in the research say while the finding that radiation following lumpectomy is effective isn't new, the study highlights that radiation is an important component of breast cancer treatment, and methods for delivering radiation have improved so they are safer. They also say the findings offer proof that double mastectomies aren't always necessary because they are no more effective at preventing recurrence.
In an accompanying comment, Dr. Thomas Buchholz, chief of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston said the research indicates that each treatment phase plays an important role.
"The incremental benefits of each component of treatment contribute to the ongoing success in reduction of breast cancer mortality rates," he wrote.
"It confirms that not skimping on any aspect of treatment leads to more women being alive without losing their breasts," said Dr. Kimberly Blackwell, director of the breast cancer program at Duke Comprehensive Cancer Center in Durham, N.C. "Just removing the cancer without radiation is not an appropriate option, as the data suggest. It's very unusual to see a tumor surgically removed and the breast remain where women don't receive radiation."
Mastectomy or Radiation?
Dr. Jay Brooks, chairman of Ochsner Baton Rouge Hematology/Oncology, said the number of women opting for double mastectomies has drastically increased over the past several years.
After getting a mammogram and seeing an abnormality, he explained, women go for breast MRIs which can make a breast appear unhealthier than it actually is.
"The number of women getting radiation declined, because women got really frightened," he said. Many women worry about spreading to the other breast or coming back, so they opt for breast removal.
"But it could have been treated with lumpectomy and radiation, and they don't have to lose their breasts," he added.
Women with breast cancer often choose to have double mastectomies because they are afraid of the side effects of radiation treatment, radiation can be costly and inconvenient, or removing the tumors may cut away too much breast tissue and they make a cosmetic decision to have their breasts removed.
"There are very few situations in my mind where I think it really is in a woman's best interest to have a mastectomy unless she wants one," said Dr. Marc Lippman, professor and deputy director of the Sylvester Cancer Center at the University of Miami's Miller School of Medicine.
Recurrence of a localized breast tumor is rare, specialists say. If cancer comes back, it will most likely be in another part of the body.
"We talk a lot about breast cancer coming back, and I think most patients think we're just talking about it coming back in the breast, so it makes sense to people that if there's a perception of risk of cancer coming back, removing breasts should reduce that risk," said Blackwell.
But breast removal isn't any more effective in preventing recurrence than having radiation, experts stress.
They hope the study data help women understand that while mastectomies are an effective treatment and women can opt for them if they choose, they can survive early stage breast cancer without sacrificing their breasts.
"If you look at the studies -- six in the world -- comparing mastectomy to breast-conserving surgery and radiation, survival is identical," said Lippman. "Survival not a second worse with lumpectomy and radiation."