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Mastectomy Not Necessary to Stop Cancer, 2 Studies Show

Removing small part of breast tissue is just as effective as taking entire breast, researchers find.

October 17, 2002|Rosie Mestel | Times Staff Writer

Removing a small portion of breast tissue is just as effective as removing the entire breast in saving the lives of women with breast cancer, according to two studies published today.

Several leading breast surgeons said that the reports, which tracked 2,552 women over 20 years, further strengthen what many scientists have long been saying: Mastectomies are not required in the vast majority of breast cancer cases.

Smaller operations, such as lumpectomies, which remove only the cancer and surrounding tissue, are just as effective at saving lives and halting the spread of cancer.

"These papers are really the nail in the coffin for skeptics who don't believe that breast preservation is as good as mastectomy for the treatment of breast cancer," said Dr. Melvin J. Silverstein, professor of surgery at USC's Keck School of Medicine and director of the breast center at the school's Norris Cancer Center. "They show you can do a little operation, save the breast and the end result in terms of living and dying is the same."

The studies, published in the New England Journal of Medicine, were conducted by researchers in the U.S. and Italy.

The U.S. study, led by scientists at the University of Pittsburgh, tracked 1,851 women with breast cancer who had been randomly assigned to receive either a mastectomy, lumpectomy or lumpectomy followed by radiation therapy. Twenty years later, the study found that all three groups had indistinguishable rates of death and of the spread of cancer to other areas of the body. After 20 years, about half of each group were alive and free of cancer that had spread.

The study found that radiation treatment after a lumpectomy reduced the risk that the cancer would recur in the breast to 14.3%, compared with 39% for lumpectomy alone.

The second study, by scientists in Milan, Italy, involved 701 women and reached a similar conclusion on the relative merits of mastectomy and a different breast-conserving procedure, called a quadrantectomy.

However, women with breast cancer often are not offered the choice of breast-preserving surgery, noted Dr. Monica Morrow, professor of surgery at Northwestern University's Feinberg School of Medicine in Chicago, in a commentary accompanying the reports.

For instance, in a survey published in 2001, she and her colleagues found that of 16,643 American women treated in 1994 for cancers either confined to the breast or with lymph node involvement, only 42.6% were treated with breast-conserving surgery.

In another survey, 29% of 231 women who sought second opinions in the years 1996 to 1999 were offered only a mastectomy at the first consultations.

"It is time to declare the case against breast-conserving surgery closed," Morrow wrote.

Breast-preserving surgery will never be possible for all women with breast cancer, Silverstein said. Women who come to the clinic when their tumors are too large and advanced will need more radical surgery.

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