Breast cancer: avoid mastectomy with pre-surgery chemotherapy

Breast cancer: avoid mastectomy with pre-surgery chemotherapy

26 Feb 2015

Patients with larger malignant tumors of the breast who undergo chemotherapy before a breast cancer operation are more likely to opt for a breast-preserving procedure, according to a new study. In other words, these patients will not proceed with a mastectomy, but a lumpectomy.

The study was conducted at the Yale University School of Medicine and Yale University Comprehensive Cancer Center. Study investigators also determined that rates of chemotherapy, known as neoadjuvant therapy, before breast operations, had increased significantly through the five-year study period, possibly because the FDA had approved better chemotherapy drugs.

“Very exciting results” according to study author

Lead investigator general surgeon, Brigid K. Killelea, MD, MPH, FACS, called the study results "very exciting." It is one of the largest studies to date on the use of chemotherapy before surgical treatment for breast cancer.

The researchers analyzed data from the National Cancer Data Base (NCDB). In all, the study involved 354,204 women with invasive breast cancer who underwent breast operations and chemotherapy either before or after their procedures, or both, from 2006 through 2011. Out of that group, 16.7% -about one in six patients- underwent chemotherapy before their operations.

This study did not look at overall survival among women who had pre-surgery chemotherapy. However, it did confirm that women with larger tumors who received chemotherapy first, did achieve to avoid breast removal. This Yale study found that 35% of women who had pre-surgery chemotherapy also had breast conservation therapy.

Advantages of pre-surgery chemotherapy

According to study author Dr. Killelea, this study enabled researches to see that:

• Over time, the percentage of women that did receive neoadjuvant therapy increased, going from 13.9% to 20.5% from 2006 to 2011
• Women with larger breast tumors were more likely to opt for pre-surgery chemotherapy and breast-sparing lumpectomy versus mastectomy toward the end of the trial period. (During a lumpectomy procedure only the tumor and surrounding tissue is removed, leaving the rest of the breast tissue intact.)
• Those who received neoadjuvant chemotherapy were 70% more likely to have a lumpectomy for tumors larger than 3 centimeters, leading to an increased rate of breast preservation. That means that those people with tumors as large as 4-8 centimeters were able to avoid a mastectomy.
• Another advantage of pre-surgery chemotherapy is that doctors can begin treatment of cancer that has spread to the lymph nodes immediately rather than waiting for the breast to heal after the procedure.

One of the first studies using a large database

"We've seen data published from clinical trials showing that neoadjuvant chemotherapy results in increased lumpectomy rates but this is really one of the first studies using a large national database that reflects what is also going on in the community hospital setting," she noted.

"Going forward, it will be interesting to see whether or not the use of neoadjuvant therapy continues to rise as newer drugs and agents are being developed all the time," Dr. Killelea said. "It will also be interesting to watch what happens to the rate of breast conservation over time. We don't know. That's why it's so important for us to have a database like NCDB."

Source: American College of Surgeons