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Lumpectomy - a continuing success story.


Results of an eight-year study continue to demonstrate that surgical removal of a segment of the breast containing a primary cancer tumor (lumpectomy) followed by radiation therapy produces as good long-term survival and disease-free rates for women as does total mastectomy, or complete breast removal. The study, reported in the New England Journal of Medicine by researchers at the National Surgical Adjuvant Breast and Bowel Project headquarters in Pittsburgh, is a continuation of research initially reported five years after excision of cancerous tumors of the breast in more than 1,800 women.

The women under observation were treated with one of three surgical procedures: total mastectomy and axillary node examination, lumpectomy with axillary node examination followed by radiation of the breast, or lumpectomy and axillary node examination without follow-up radiation. In every instance, individuals in the study had tumors less than 4 cm. in size, with no evidence of skin involvement, or spread (metastasis) to other parts of the body. Women treated by any of the three surgical procedures whose lymph nodes were positive for cancer cells were given chemotherapy with or without the radiation therapy.

Ninety percent of the women treated with radiation therapy following lumpectomy had no evidence of another tumor in the breast where the segment had previously been removed. Those who did not undergo radiation therapy had nearly a 30 percent greater incidence of recurrence. Comparisons of women who underwent total mastectomy versus those who had had a lumpectomy with or without radiation therapy demonstrated insignificant differences for maintaining a disease-free state. Overall survival rates were similar in all three groups, averaging about 71 percent after eight years.

The study's researchers state, "The data continue to indicate that lumpectomy followed by breast irradiation in all patients...and chemotherapy in those women with positive [lymph] nodes is appropriate therapy for Stage I and II breast cancer, provided that the edges of the resected specimens are free of tumor." Primary, or Stage I and II, tumors are those that are 4 cm. or less in size, are not attached to underlying muscle or the chest wall, and show no evidence of either skin involvement or metastasis to other body locations. The researchers further indicate that their data continue to favor saving the breasts of patients with breast cancer over that of total removal. (New England Journal of Medicine, March 30, 1989;320:822-828.)
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Title Annotation:National Surgical Adjuvant Breast and Bowel Project research
Publication:Medical Update
Date:Jun 1, 1989
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