Breast cancer: surgery linked to positive patient results

Breast cancer: surgery linked to positive patient results

2 Dec 2015

A study of women with stage IV breast cancer finds that survival has improved and is increasingly of prolonged duration, particularly for some women undergoing initial breast surgery.

A study of more than 20,000 female patients

Mary C. Schroeder, Ph.D., of the University of Iowa, Iowa City, and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) program to evaluate the patterns of receipt of initial breast surgery for female patients with stage IV breast cancer in the United States.

The study included more than 20,000 female patients with stage IV breast cancer diagnosed between 1988 and 2011 and who did not receive radiation therapy as part of the first course of treatment. The researchers analyzed the differences in survival, particularly survival of at least 10 years, by receipt of initial surgery to the primary tumor.

Clinical factors that correlated with prolonged survival included surgery, tumor size, hormone receptor status, marital status, and year of diagnosis.

Local therapy with surgery: essential for prolonged survival

Among the study population, the results showed that:

  • The median survival increased from 20 months (1988-1991) to 26 months (2007-2011)
  • During this time, the rate of surgery declined
  • Receipt of surgery was associated with improved survival
  • For women diagnosed as having cancer before 2002, survival of at least 10 years was seen in 9.6% and 2.9% of those who did and did not receive surgery, respectively.

"A large benefit for many women with stage IV breast cancer with surgery to the intact primary tumor is unlikely, especially as an ever-increasing array of more potent and targeted drugs may be able to provide better control or even eradication of systemic disease," the authors write. However, they add that "since systemic therapies cannot yet manage all macroscopic [large enough to be seen with the naked eye] disease fully, local therapy with surgery to the primary tumor may offer critical disease control for select patients and could be an essential component of prolonged survival."


Breast cancer disparities associated with racial/ethnic identity

"While this study's overarching focus is indeed meaningful, it is also informative to place results from this report in the context of conversations regarding breast cancer disparities associated with racial/ethnic identity, young age, and country of origin," writes Lisa A. Newman, M.D., M.P.H., formerly of the University of Michigan, Ann Arbor, in an accompanying commentary.

"Thomas and colleagues found a disproportionately high prevalence of African American women among their stage IV study population, and African American women were also 30% less likely to undergo surgery. This treatment imbalance raises questions regarding selection of patients that are triaged toward more aggressive care."

Age: independent predictor of prolonged survival

"Furthermore, while the population-based incidence rates of breast cancer in women younger than 45 years have been stable over the past several decades, we are indeed seeing a larger number of young patients with breast cancer because census data confirm that this demographic has grown by nearly 10 million since 1980."

"Unfortunately, the population-based incidence of stage IV breast cancer has doubled among young American women but happily, Thomas et al found that younger women were more likely to undergo surgery, and age younger than 45 years was an independent predictor of prolonged survival."

Source: eCancer News

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