Lumpectomy for Large Breast Cancers?
Some Women With Large Cancers Can Be Treated With Lumpectomy, Say Researchers
Dec. 5, 2003 (SAN ANTONIO) -- Women with large breast tumors -- not usually considered candidates for lumpectomy -- actually fare extremely well if they are selected carefully. That's the finding in the largest study of its kind.
Doctors at the University of Texas M. D. Anderson Cancer Center in Houston say they have identified four factors that can predict whether women with large tumors can safely undergo a lumpectomy, where the cancer and surrounding normal tissue are removed but the appearance of the breast is maintained.
The findings are good news for the thousands of women who are now routinely referred for a mastectomy, or full removal of the breast, says researcher Thomas Buchholz, MD, associate professor of radiation oncology at M. D. Anderson.
The study, presented here at the San Antonio Breast Cancer Symposium, should help to establish acceptable guidelines for use of lumpectomy -- also called breast-sparing surgery -- in women with large tumors, which is currently considered controversial, he says.
"It is clear that for women with small tumors, breast-sparing surgery is a very safe and effective approach," Buchholz tells WebMD. "For women with larger tumors, chemotherapy can shrink the tumor sufficiently before surgery, thus allowing the patient to avoid mastectomy.
"But some small studies have found that this approach is associated with a higher risk that the cancer will return, making some doctors reluctant to try it."
The new study, which found that the approach is associated with a very low risk of recurrence if patients are selected carefully, should help change that, Buchholz says.
The researchers studied 357 women with breast cancers bigger than 2 centimeters, all of whom were given chemotherapy prior to lumpectomy. After five years, breast cancer returned in only 6% of the women -- "a rate similar to what we see in women with small tumors," he says.
The researchers also identified four factors that predicted whether the cancer would come back with lumpectomy:
- If the disease had spread to the lymph nodes prior to chemotherapy
- If the tumor did not shrink to less than 2 centimeters after chemotherapy
- If the tumor did not shrink down in a single sphere, like a balloon, after chemotherapy, but rather broke up into pieces that were spread apart
- If cancer cells spread to the channels that connect that breast and lymph nodes
"Any one of these factors is not enough to recommend against breast-sparing therapy," Buchholz says. "But if a patient has three or four of these factors, a mastectomy is probably a better option."
C. Kent Osborne, MD, director of the Breast Center at Baylor College of Medicine in Houston and co- chair of the symposium, says the study offers very helpful information for women undergoing the agonizing decision of whether to undergo a mastectomy.
"Most of us are very concerned about doing breast-conserving surgery after chemotherapy, particularly in patients with large tumors," he tells WebMD. "This information is very helpful for selecting those patients who should not have breast-sparing therapy and those that should."