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New treatment may reduce breast surgeries.

New treatment may reduce breast surgeries

Researchers this week described an experimental therapy that may make radical breast surgery, or mastectomy, unnecessary in most women with tumors previously considered too large to treat more conservatively. The treatment shrinks tumors to a fraction of their original size, so surgeons can remove them using a less disfiguring operation popularly known as a "lumpectomy."

Apparent successes in nearly all of the first 90 patients studied suggest that total removal of cancerous breasts may fall almost entirely out of practice within the next five years, some experts say. But others express skepticism of such far-reaching conclusions, saying there remain compelling reasons for women to opt for mastectomy. Either way, the new findings provide fuel for a growing debate about how best to treat this potentially fatal cancer, which will strike 142,000 U.S. women this year.

Increasingly, physicians in the United States and abroad recommend lumpectomies for small breast tumors, especially when no evidence exists the cancer has spread. But tumors greater than 2 or 3 centimeters in diameter generally spur surgeons to perform a modified radical mastectomy, where they remove the entire breast and some surrounding tissues. Chemotherapy treatments often follow in an attempt to destroy any remaining tumor cells (SN: 3/4/89, p.135).

Gianni Bonadonna and his colleagues at the Instituto Nazionale Tumori in Milan, Italy, reversed this common therapeutic sequence for women with large tumors by treating them first with standard anticancer drugs for three months, then performing surgery. They found chemotherapy shrunk 95 percent of tumors with diameters of 3 to 5 cm and 73 percent of tumors measuring 5 to 8 cm to less than 3 cm, allowing surgeons to do lumpectomies. Even the largest tumor, 11 cm, withered to 3 cm.

"The findings imply that the classical indication for primary mastectomy can now be challenged," Bonadonna told the annual meeting of the American Society of Clinical Oncology in San Francisco. With the first group of patients now more than one year into the study, none has experienced a cancer recurrence. Although long-term survival data will take years to gather, Bonadonna says, "Let's begin to dismantle the mutilating surgery. Then we shall see whether these data will make an impact on survival figures." He predicts that by 1994, the 100th anniversary of the first published description of radical mastectomy in a surgical journal, the procedure will be all but obsolete -- an opinion echoed by oncologist Nikolay Dimitrov of Michigan State University in East Lansing.

Others, however, note that despite the encouraging results, women may be slow to trust the experimental regimen. Both Bonadonna and Hendre Falkson of the University of Pretoria in South Africa say all their women colleagues have told them they'd opt for mastectomy with reconstructive surgery rather than worry about the risk of recurrence that might come with lumpectomy. Moreover, Falkson notes that even under Bonadonna's regimen, lumpectomy patients receive six weeks of post-surgical radiation therapy. "Six weeks of radiotherapy is not innocuous treatment," she says.

Emphasizing that only large-scale, prospective trials of various treatments will settle the debate, she decries U.S. doctors' failure to enter their patients in controlled trials where treatment variables can be standardized and results interpreted in statistically meaningful ways. Of the tens of thousands of new breast cancer patients identified each year, she says, only a few hundred enroll in such research protocols.
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Title Annotation:chemotherapy, then surgery
Author:Weiss, R.
Publication:Science News
Date:May 27, 1989
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