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Breast removal may only reduce cancer risk for younger women
Source: (cancerfacts.com)
Thursday, February 25, 2010
HOUSTON – Feb. 25, 2010 – Women over 60 with early stage cancer in only one breast need not consider removal of the unaffected breast to prevent a recurrence, say researchers.
Led by Dr. Isabelle Bedrosian, assistant professor in M. D. Anderson's Department of Surgical Oncology, researchers conducted a population-based study using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry. They found that preventive removal of a healthy breast, known as contralateral prophylactic mastectomy (CPM), may provide a survival benefit only in women younger than 50 with early-stage disease and tumors that don't respond to estrogen (estrogen receptor negative).
"Our research found that breast cancer patients over the age of 60 can be reassured that they will not benefit from CPM," said Bedrosian in a prepared statement. "However, there are other populations, such as women between the age of 50 and 60, where the findings about the procedure remain less clear."
"In addition, for young women with early stage, estrogen receptive positive breast cancer who receive tamoxifen for only five years, we really do not know whether they would derive a life-long protective effect from a second breast cancer event," she added. "Therefore, for some additional breast cancer patients, CPM may very well be a medically-appropriate option."
In the study, the researchers identified 107,106 breast cancer patients who underwent a mastectomy for treatment, as well as a subset of 8,902 women who had the opposite, unaffected cancer removed in an effort to prevent recurrence. It is the first population-based study to find an association between the procedure and survival in any group of breast cancer patients. The results were published online Feb. 25 in the Journal of the National Cancer Institute.
The findings should help both the women making this often distressful decision and the physicians providing their care. According to Bedrosian a growing number of breast cancer patients are opting for the procedure; recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States.
"In our clinic, we've seen a dramatic increase in the number of women requesting CPM, and across the breast cancer community, studies have shown that the utilization of the procedure is skyrocketing," said Bedrosian, the study's co-corresponding author. "Until now, we've counseled these patients on a very important, personal decision in a vacuum. With our study, our goal was to understand the implications of the surgery and who may benefit."
For the study, all of the women were treated for stage I to stage III breast cancer between 1998 and 2003. Patients were stratified for estrogen receptor (ER) status, stage of disease and age. Breast cancer-specific survival served as the study's primary endpoint.
Using standard statistical analysis Dr. George J. Chang, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology and study co-author, examined survival of patients who had undergone CPM to that of the general population, as well as the non-cancer related versus cancer-specific survival.
"All alternative analyses resulted in the same conclusion; we found one group for whom this surgery offers a true survival benefit," Chang said.
Those who benefited included those younger than age 50 with stage I or II cancer with ER negative disease had a survival benefit of 4.8 percent at five years. This group of women for whom CPM provided a survival benefit represents less than 10 percent of the breast cancer population.
Both Bedrosian and Chang expect that future research will show increased survival benefit with longer follow-up in the population, as a patient's likelihood of getting a second breast cancer increases with time.
The researchers cautioned, however, that while the findings should serve as a guideline for breast cancer patients and their physicians to have an informed, medically-based discussion about CPM, the study results do not show that CPM is medically inappropriate for all others with the disease. The study captured neither family history nor BRCA status; it also did not include ductal carcinoma in situ (DCIS), or stage 0 breast cancer patients.
SOURCE: adapted from press material provided by MD Anderson via Eurekalert
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