Comparing breast-conserving surgery and breast-removal surgery after chemotherapy in patients with breast cancer

This study compared the effectiveness of breast-conserving surgery (BCS) to mastectomy (breast-removal surgery) after chemotherapy in patients with breast cancer. The authors found that BCS does not result in a lower survival in these patients.

BC is one of the most common forms of cancer in women. Standard care is usually a combination of chemotherapy, surgery, and radiotherapy. Chemotherapy is commonly given before surgical treatment to reduce tumor size. This is called neoadjuvand chemotherapy (NAC). This allows surgeons to use BCS instead of mastectomy. BCS is associated with better psychological outcomes for patients. However, it increases concerns regarding relapse.

Previous studies have shown that chemotherapy after surgery (adjuvant chemotherapy or AC) has improved the outcomes of BCS and made this surgery as effective as mastectomy. However, the long-term outcomes in patients treated with NAC before BCS or mastectomy are still not clear. 

A total of 561 patients with breast cancer who had NAC were included in this study. After NAC, 362 patients were treated with BCS and 199 were treated with mastectomy. Patients were followed up for an average of 6.8 years.

The 5-year disease-free survival was 90.9% in patients treated with BCS and 82.9% for the mastectomy group. The 5-year overall survival was 95.3% for patients treated with BCS and 85.9% in patients treated with mastectomy.

Factors associated with a higher risk of recurrence were large tumors and triple negative status (no hormone receptors or HER2 protein on cancer cells).

The authors found that BCS does not impair disease-free and overall survival in patients treated with NAC. The authors suggested that BCS can be considered a safe-treatment option, even in larger tumors. 

This study was carried out in a hospital in the Netherlands. The results of this study may not translate well to a global population. This study was based on medical records. Patients were not randomly assigned to BCS or mastectomy. Patients who underwent mastectomy were more likely to have a larger tumor and/or a tumor that was more aggressive in character. This might bias the results.