Breast conservation is linked to improved self-esteem, body image and quality of life when compared to women undergoing mastectomy with or without reconstruction, so expanding the indications for safe breast conservation is critical.
Kari M. Rosenkranz, MDResults of a new clinical trial show that patients with two to three lesions in one breast who underwent breast-conserving lumpectomy followed by radiation had similar rates of local recurrence as patients who had a single lesion. These results mean some patients with multiple sites of disease in the same breast may choose breast-conserving surgery instead of the historically recommended mastectomy (full breast removal).
“Although mastectomy is a good choice for some women based on their values, preferences or features of the breast cancer, most women who can safely preserve their breast at the time of diagnosis choose to do so,” says Dartmouth Cancer Center surgical oncologist and co-lead author Kari M. Rosenkranz, MD. “Breast conservation is linked to improved self-esteem, body image and quality of life when compared to women undergoing mastectomy with or without reconstruction, so expanding the indications for safe breast conservation is critical.”
To the authors’ knowledge, this is the only study in the world that has prospectively addressed the oncologic safety of lumpectomy for multiple ipsilateral breast cancer.
The trial enrolled women over the age of 40 who had two or three sites of breast cancer in the same breast. Patients were screened for eligibility for treatment with lumpectomy followed by whole-breast radiation therapy. Of the 204 evaluable patients, six experienced local recurrence, for a five-year estimated local recurrence rate of 3.1 percent. This rate was similar to the local recurrence rates shown in prior studies for patients with a single breast tumor who also underwent breast-conserving therapy.
“Based on these data, surgeons can now safely offer breast conservation to women diagnosed with two or three tumors in the same breast,” says Rosenkranz. “The choice would involve a shared decision-making conversation with the patient regarding her preferences and values as well as expected cosmetic outcomes.”
Results of the study were presented at the San Antonio Breast Cancer Symposium and the International Society of Surgical Oncology Annual Meeting and are newly published in the Journal of Clinical Oncology.
More choices for more patients leads to better long-term outcomes. The rate of diagnosis of multiple ipsilateral breast cancer, or more than one lesion in the same breast, has been increasing due to more sensitive breast imaging techniques. Rosenkranz notes these findings are increasingly relevant as more women are impacted.