Modern therapies minimize recurrence after lumpectomy

Issue: June 25, 2018

Researchers observed a 4.2% local recurrence rate among women who underwent breast-conserving surgery followed by radiation and systemic therapy in the last 2 decades, according to a study presented at The American Society of Breast Surgeons Annual Meeting.

“[Although] survival rates are equal, lumpectomy traditionally carries a greater risk [for] local recurrence than mastectomy, and many women face a difficult trade-off when making treatment decisions,” Heather Neuman, MD, MS, FACS, associate professor of surgical oncology at University of Wisconsin-Madison School of Medicine and Public Health, said in a press release. “This more positive, contemporary data may make their choice a little easier.”

Neuman and colleagues used data from nine Alliance for Clinical Trials in Oncology legacy studies to assess local recurrence rates after breast-conserving therapy. The analysis included 6,927 women diagnosed with stage I to stage III breast cancer from 1997 to 2011 who underwent lumpectomy and modern-era radiation and chemotherapy or other systemic therapies.

Researchers observed a 5-year local recurrence rate of 4.2% (95% CI, 3.7-4.8) among women who had breast conserving surgery and modern-era therapy.

“This compares with the generally accepted figure of about 5% to 10% for lumpectomy recurrence, which is typically based on older treatment protocols,” Neuman said in the release.

Recurrence rates appeared lowest among women with triple-positive breast cancer (3%; 95% CI, 1.9-4.8) and highest among women with triple-negative breast cancer (6.9%; 95% CI, 5.6-8.4).

More positive lymph nodes appeared associated with a higher risk for local recurrence (more than three nodes, HR = 3.8; 95% CI, 2.5-5.6). Older age appeared associated with a lower risk for recurrence.

“Clearly this new data shows that recurrence with breast conservation has diminished significantly overall,” Neuman, said. “Additionally, in today’s age of multimodality, personalized breast cancer therapy, stratifying recurrence risk by cancer subtypes helps women and their physicians to make more informed decisions. This study absolutely has added important new information to my conversations with patients about the relative risks and benefits of lumpectomy and mastectomy.” – by Cassie Homer

Reference:

Neuman H. Local recurrence rates after breast conserving therapy in patients receiving modern era therapy. Presented at: The American Society of Breast Surgeons Annual Meeting; May 2-5, 2018; Orlando, Florida.

Disclosures: Neuman reports no relevant financial disclosures.