BMJ 2002;325:921 ( 26 October )
is as effective as mastectomy for breast cancer
is just as effective as mastectomy for treating small
breast cancers, conclude two studies from Italy and
the United States.
from the University of Pittsburgh studied 1851 women
with tumours up to 4 cm in diameter. In more than
a third of cases the cancer had spread to
the axillary lymph nodes (New
England Journal of Medicine 2002; 347:1233-41)
women were randomly assigned to one of three treatments:
a mastectomy, a lumpectomy alone, or a lumpectomy followed
by radiation. The women were monitored for
20 years as part of the national surgical
adjuvant breast and bowel project.
women had the same chance of being alive after 20 yearswith
or without cancerregardless
of whether the breast had been removed or
they had received a lumpectomy.
radiation treatment significantly reduced the chance
of another cancer arising in the same breast, sparing
many women a mastectomythe
usual treatment for a second cancer. The risk of
a second cancer developing in the same breast was about
40% in women who had a lumpectomy without
radiation and 14% in women who also had
is time to declare the case against breast conserving
therapy closed and focus our efforts on new strategies
for the prevention and cure of breast cancer,"
writes Dr Monica Morrow of Northwestern University's
Feinberg School of Medicine, Chicago, in an accompanying
editorial. The findings, she writes, "should
convince even the most determined sceptics."
a second study, from the European Institute of Oncology
in Milan, Italy, doctors excised a little more of the
breast than a lumpectomy and only compared
women whose tumours were 2cm or less in diameter
(New England Journal
of Medicine 2002;347:1227-32)
1973 to 1980 the researchers monitored 701 women
and found that the 20 year death rate from breast
cancer was 24.3% in the 349 women who
had a mastectomy and 26.1% in the 352 women
who underwent less radical surgery.
1976, patients in both groups whose tumour had
spread to the axillary nodes also received adjuvant
chemotherapy with cyclophosphamide, methotrexate,
surgery is therefore the treatment of choice for women
with relatively small breast cancers," conclude
clusters of cancer cells, which occur in 16% to 37%
of women with breast cancer, can be detected with ultrasonography
or magnetic resonance imaging. In such cases doctors
often advise a mastectomy, as a lumpectomy
cannot remove these clusters.
Dr Morrow and other experts said the
two studies indicated that it made no difference whether
tiny clusters of cancer cells were removed
or left behind.
women to a mastectomy because we now have a technique
that is sensitive enough to detect microscopic foci
is not a step forward," she writes.
zum Volltext New England Journal of Medicine
zum 2. Volltext New England Journal of Medicine