Early Lumpectomy Doesn't End Cancer Risk
Lumpectomy Safe, but Long-Term Vigilance a Must in Young Women
Nov. 3, 2003 -- Lumpectomy -- removal of the breast cancer tumor but not the entire breast -- is an excellent option for many women with breast cancer. But the long-term risk of recurrence is high in young women, a new study suggests.
The study shows that young women -- 40 and under -- who have lumpectomy have a slightly higher risk of recurrent cancer 10 years after breast cancer surgery than women who have mastectomies.
This doesn't mean women shouldn't have a lumpectomy. But it does mean that women who have lumpectomies must continue to see a breast cancer specialist, says Rodrigo Arriagada, MD, professor of oncology at the Instituto de Radiomedicina in Santiago, Chile, and the Gustave-Roussy Institute in Villejuif, France.
Lumpectomy involves removal of the cancerous tumor and immediately surrounding breast tissue. Lymph nodes under the arm are also often removed. This surgery, as opposed to mastectomy, maintains the normal breast appearance.
"We consider [lumpectomy] quite safe," Arriagada tells WebMD. "But it is important to say to these patients that they will have a small, higher risk over years compared to mastectomy patients."
A 22-Year Study
From 1972 through 1979, Arriagada's team enrolled 179 French women with early-stage breast cancer no bigger than 2 cm. They agreed to be randomly assigned either to mastectomy -- removal of the entire cancerous breast -- or lumpectomy plus radiation treatment. Arriagada and colleagues report the findings in the Nov. 3 issue of Annals of Oncology.
In the first five years after treatment, the women who got a lumpectomy had a lower risk of seeing their cancers come back. But after five years, their risk was higher than that of the mastectomy patients.
Was this just a fluke? To find out, the researchers analyzed a database with information on more than 1,800 women with small breast tumors. For 10 years after treatment, those who had lumpectomy did just as well as mastectomy patients. But after 10 years, there were more breast cancers among women who had lumpectomies at a young age -- 40 or younger.
The Key: Long-Term Follow-Up
The findings don't mean young women with breast cancer shouldn't get lumpectomies. They do suggest that women who choose lumpectomy must be prepared for lifelong follow-up care.
"This is important because younger patients prefer to keep their breasts," Arriagada says. "You have to give them this information, knowing that they have to continue follow-up care for the long term -- 20-25 years. This is the most important message. Because in most cancer centers they finish follow-up by specialists in 10 years. We say they should continue with specialists and, after eight to 10 years, start making a special effort to detect recurrent or new cancers."
Pamela N. Munster, MD, a medical oncologist at Moffitt Cancer Center in Tampa, Fla., specializes in the treatment of young women with breast cancer. She says it's not clear from Arriagada's study that the tumors seen 10 years after lumpectomy are really recurrent cancer.