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BMJ 2000;321:261 ( 29 July )
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Lumpectomy as good as
mastectomy for tumours up
to 5 cm
Scott Gottlieb, New York
In women with breast cancers up to 5 cm
across the rates of long term survival and
metastasis-free survival are similar for
mastectomy and breast conserving treatment,
according to a new study.
Previous studies have shown both
approaches to be similar for women with
tumours equal to or less than 2 cm across, for
which breast conserving treatment is widely
used. But this is the first study to show
equally good long term results even when the
width of a tumour is as much as 5 cm.
The results suggest that breast conserving
treatments, instead of mastectomy, could
now be offered to most women with breast
cancer, according to the researchers (Journal
of the National Cancer Institute
2000;92:1143-50).
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Related content
Surgical Oncology
Cancer: breast
Women who have tumours less than 2 cm
across often undergo lumpectomy. For women with larger tumours, however, there
was previously little evidence that breast conserving surgery offered long term
benefits, according to the team of researchers led by Dr Harry Bartelink of the
Netherlands Cancer Institute, in Amsterdam. For these women the recommended
treatment is often modified radical mastectomy.
In the new study, researchers compared the survival of 868 women who were
randomly assigned to undergo either lumpectomy or modified radical mastectomy to
see whether women with tumours as wide as 5 cm could be treated effectively with
breast conserving surgery. Of these women, 696 had a tumour that measured 2.1-5 cm.
Ten years after surgery, no significant difference in survival was found in women
with larger tumours, regardless of the type of surgery. Almost two thirds of the
women in each group were still alive after 10 years. In addition, the cancer was no
more likely to metastasise in women who had had a lumpectomy than in women who
had had a mastectomy.
"This international trial has now shown that breast conserving therapy results in a
similar survival rate as mastectomy, even for patients with larger tumours," Dr
Bartelink said.
"Breast conserving therapy instead of mastectomy can therefore now be offered to the
large majority of the breast cancer population as the majority of patients in the
Western world nowadays present with tumours smaller than 5 cm."
Researchers, however, did find that about 20% of women in the lumpectomy group
had a recurrence within 10 years, compared with about 12% in the mastectomy group,
even if the recurrence did not affect 10 year survival.
Researchers said that it was important for further studies to establish which subgroup
of women is at greatest risk of recurrence.
© BMJ 2000
Rapid Responses to:
NEWS:
Scott Gottlieb
Lumpectomy as good as mastectomy
for tumours up to 5 cm
BMJ 2000; 321: 261 [Full text]
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response to this article
Lumpectomy is not just lumpectomy
Stephan Larsson (27 July 2000)
Clean margins
Gordon Caruana-Dingli (29 July 2000)
Re: Lumpectomy is not for developing countries
Tarek Elatrozy (30 July 2000)
Lumpectomy: are there limiting factors?
jamal masad melhem (17 September 2004)
Lumpectomy is not just lumpectomy
Stephan Larsson,
Assistant Professor,
Dept of Surgery,
University of British
Columbia, Canada
Vancouver Island
Cancer Centre
Send response to
journal:
Re: Lumpectomy is not
just lumpectomy
It is heartening to see that for breast cancers up to
5cm in size, there are options other than radical
mastectomy. However, lumpectomy is NOT such an
option. It is the case, however, that lumpectomy plus
radiotherapy is an option, and I assume that this is
the treatment which is being described in the Gottlieb
article.
Clean margins
Gordon CaruanaDingli,
Senior Registrar
Surgeon
St Luke's Hospital,
Malta
27 July 2000
29 July 2000
Perhaps we should say lumpectomy with clean
margins and radiotherapy.
Send response to
journal:
Re: Clean margins
Re: Lumpectomy is not for developing
countries
Tarek Elatrozy,
Ass. lecturer in general
surgery
Tanta university
hospital. Egypt
Send response to
journal:
Re: Re: Lumpectomy
is not for developing
countries
30 July
2000
The current evidence of the equivalent effectivness of
lumpectomy and modified radical mastectomy
(MRM)in the treatment of breast neoplastic lesions up
to 5 cm may be interepted in favour of MRM. In
developing countries many surgeons can only trust
their surgical skills to improve long term and
metastasis-free survival for patients with operable
breast carcinoma. The lack of facilities as well as the
cost of other adjuvant treatment modalities as well as
the absence of organised national multidiciplinary
breast care programs can dramatically increase the
incidence of recuurent brast lesions after mastectomy.
Many of these lesions can easily , under lack of non
organised haphazard follow ups, progress to
unoperable lesions and may therefore increase the
overall mortality and morbidity of operable breast
lesions treated by lumpectomy rather than by well
performed MRM
Lumpectomy: are there limiting
factors?
jamal masad melhem,
associate professor of
surgical oncology
jordan uinversity
amman 11941
Send response to
journal:
Re: Lumpectomy: are
there limiting factors?
17 September
2004
The term lumpectomy is a misnomer i would agree
that WLE with safety margin and proper staging of the
axilla together with radiotherapy for patients having
T2 tumor would provide matching loco regional control
as modified radical mastectomy. At Jordan university
hospital in Amman, we used to practice conserving
breast surgery for the last fifteen years, we found two
significant reasons depriving patient, with T2 tumor,
of their chance of keeping the breast. when they had
small breast(cup A)or had excisional biopsy for
diagnosis. We could overcome these two obstacles in
few patients by using local flaps to compensate for
skin and glandular loss. Centrally located T2 tumors
were not excluded from our conserving policy if sound
oncological and cosmetic principles could be fulfilled.
Competing interests: None declared