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News Americas

In a Modified Radical Mastectomy, such as in this operation, the pectoralis muscle is left intact. Breast tissue (with tumor) is dissected off along the pectoralis fascia plane. Such surgery could be avoided when applying radiation after a lumpectomy, according to latest research. (Photo: Jmelendres)
Aug 14, 2012 | News Americas

Radiation after lumpectomy helps prevent need for mastectomy

by Surgical Tribune

HOUSTON, Texas, USA: For most older women with early-stage breast cancer, radiation after lumpectomy helps prevent the need for subsequent mastectomy, researchers have found. Their findings indicate that current thinking on the risks and benefits of radiation for early-stage breast cancer in older women may be inaccurate.

National treatment guidelines state that older women with early-stage breast cancer that has not spread to the lymph nodes and that is driven by estrogen in the body can be treated with lumpectomy and estrogen blockers without the need for radiation. Dr. Benjamin Smith of the University of Texas MD Anderson Cancer Center in Houston and his colleagues evaluated data on 7,403 women aged 70 to 79 years who had been treated with lumpectomy for such breast cancers between 1992 and 2002. Their data were contained in the Surveillance, Epidemiology and End Results-Medicare database, which links cancer registry information to Medicare's master enrollment file. Approximately 88 percent of these women received radiation after their lumpectomy.

The investigators found that within ten years of treatment of their breast cancer 6.3 percent of women who had not undergone radiation eventually had their breast removed by mastectomy, compared with only 3.2 percent of women who had received radiation. The reasons for mastectomy are not reported by this dataset, but the most likely reason for mastectomy in this patient group is recurrence of cancer in the breast.

The researchers were also able to identify which women were more and less likely to benefit from radiation. Specifically, radiation did not appear to benefit women between the ages of 75 and 79 with tumors that were not high grade (which contain cells that look only moderately abnormal under a microscope), suggesting that this group can probably skip radiation. Patients with high-grade tumors (which contain very abnormal-looking cells), regardless of age, seemed to derive the most benefit from radiation.

"These data are important because they suggest that radiation is likely of some benefit to certain women where national guidelines say that radiation is not needed," said Smith. "Our data could be helpful to women when they decide whether or not to undergo radiation," he added.

The study, titled "Effectiveness of radiation for prevention of mastectomy in older breast cancer patients treated with conservative surgery," was published online ahead of print in CANCER, a peer-reviewed journal of the American Cancer Society.

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