Mastectomy Needless for Early Cancer
Many Women Not Told That Breast-Conserving Surgery Is an Option
In 1973, Veronesi's group began a study of 701 women receiving either lumpectomy plus radiation therapy or radical mastectomy. In the 20-year follow-up reported this week, Veronesi finds that the overall survival rate in the two groups was virtually identical.
In 1980, Fisher began enrolling 1,800 women in what became a 20-year study. It produced similar results: Total mastectomy offers no advantage over either lumpectomy or lumpectomy plus radiation therapy.
The studies show the benefits to the patient, but they also add critical information about the biology of cancer, Fisher tells WebMD. "These studies demonstrate that surgery was not going to be ultimate answer," he says. "They show that so much can be done systemically, treating the patient with chemotherapy, before and after surgery."
In fact, for the past 15 years, lumpectomy has been an accepted alternative. There are laws in some 30 states stating that a physician must inform a woman that she is eligible for either procedure, says Brawley.
Yet despite all the scientific data, "which is unequaled in the literature on the local treatment of cancer, many women today are not offered the option of breast-conserving therapy," writes Monica Morrow, MD, in an editorial accompanying both studies. She is a researcher with the Northwestern University School of Medicine in Chicago.
Morrow and colleagues found that only 43% of women with early-stage breast cancers were being treated with the breast-conserving approach, she writes. Lumpectomy is still "viewed as a less-aggressive therapy appropriate for only for women with a good prognosis," she writes.
"It is time to declare the case against breast-conserving therapy closed and focus our efforts on new strategies for the prevention and cure of breast cancer," Morrow says.
Says Brawley, "I'm happy, thrilled, that these two authors are able to say, 'I told you so.'" -->