ROCHESTER, Minn. — A promising new report by a team at the Mayo Clinic suggests breast cancer patients with multiple tumors in one breast may be able to avoid having a mastectomy — surgical removal of the breasts. Their study finds that this depends on whether surgeons can successfully remove the tumors while leaving enough breast tissue intact. Instead of a mastectomy, patients would receive breast-conserving therapy; a lumpectomy followed by whole-breast radiation therapy.
“I am excited about these findings because it will empower patients and the multidisciplinary care teams caring for patients to be thinking about this option for women who may want to preserve their breast,” says Judy Boughey, M.D., lead author and breast surgical oncologist, and the W.H. Odell Professor of Individualized Medicine, in a media release. “Some patients may still prefer or require a mastectomy, and that is a perfectly fine approach. But being able to provide more patients diagnosed with breast cancer with a choice is a great step forward.”
This project was a prospective, single-arm trial in which all enrolled women received identical treatment. Researchers assessed data encompassing 204 eligible women over 40 years of age that had two or three separate areas of breast cancer in the same breast and expressed an interest in breast conservation. All patients received a preoperative mammogram and/or ultrasound, and all but 15 women had a breast MRI. Patients received lumpectomies to remove tumors, then a whole-breast radiation treatment complete with radiation boost to each lumpectomy site. After that, researchers tracked each participant for five years, focusing on any subsequent breast cancer events.
A breast MRI can be crucial to a surgical decision
Data after five years revealed that at the average follow-up period of 66.4 months, six patients experienced a local breast cancer recurrence. The rate of cancer local recurrence, meanwhile, was 3.1 percent. According to Dr. Boughey, this is a fantastic outcome that is quite similar to the local recurrence rate for patients with a single tumor in a breast who received breast-conserving therapy.
Historically, doctors usually recommend that women with multiple tumors in one breast should have a mastectomy. These new findings indicate many patients can opt for a less invasive option with faster recovery, ultimately resulting in better patient satisfaction and cosmetic outcomes.
Study authors also note the local recurrence rate was lower in patients who had a preoperative MRI compared to those who did not have an MRI before surgery. Dr. Boughey adds that for patients with two or three tumors in a breast thinking about breast conservation, they should consider having an MRI before surgery to ensure there is not more extensive disease. Numerous additional factors, such as breast size, can influence whether a patient should be offered breast-conserving therapy, she concludes.
The Alliance in Clinical Trials in Oncology and Mayo Clinic Comprehensive Cancer Center conducted this research.
The study is published in the Journal of Clinical Oncology.
