From University of Newcastle upon Tyne
Breast cancer research may lead to fewer mastectomies Women with breast cancer which fails to show up in routine scanning do not necessarily need a mastectomy to maximise their chances of survival, according to research by the University of Newcastle upon Tyne, England.
A study led by Tom Lennard, head of the Department of Surgery, found that surgical removal of the tumour, rather than the whole breast, was equally effective at preventing a recurrence of the cancer despite the fact that tumours which escaped detection tended to be large and aggressive.
Breast cancer sufferers who have had false-negative scans are frequently advised to have mastectomies because of concern that the tumour might otherwise recur but be difficult to detect by scanning in check-ups.
Mr Lennard and his team have changed their policy as a result of their findings and are now advising false-negative breast cancer patients at the Royal Victoria Infirmary in Newcastle to have treatment which is appropriate to factors including the type and extent of the tumour. This will frequently involve less radical surgery than a mastectomy.
Each year 38,000 women are newly diagnosed with breast cancer in the UK and 13,100 die from the disease. Scanning, or mammography, is the mainstay of diagnosis although it is common knowledge that about one in ten women with breast cancer will produce false-negative results because the tumour is ‘mammographically invisible.’
The Newcastle research was based on a computer search of medical records which identified 40 women in Northern England who developed breast cancer within six months of having a negative mammogram.
All except one patient agreed to have surgical treatment. Seventeen had mastectomies, with a further eight going on to have this treatment after initially having only the tumour removed. The remaining 14 patients had their tumours removed and radiotherapy.
Only in one case was there recurrence of the tumour which had been surgically removed and this patient went on to have a mastectomy. Four other patients who developed tumours in their other breast also had mastectomies.
Eighteen months after treatment, 34 of the women were clear of the disease, one was awaiting surgery after developing secondary cancer and five had died from breast cancer.
Mr Lennard, who is also a consultant surgeon, believes that all breast cancer specialists should review their policy of advising ‘false negative’ patients, following the publication of the research findings in the current edition of the academic journal, The Breast.
As part of the study, the Newcastle team examined the factors associated with mammographically invisible tumours and found that they tended to be large, aggressive tumours of a common variety. These findings are contrary to the commonly-held belief that such tumours go undetected because they are small and of an unusual variety. The average age of the patients identified as suitable for the study was 48, suggesting that younger women are more likely to have false-negative scans, perhaps because of the higher density of their breast tissue. The UK’s national breast screening programme applies to women from the age of 50.
Mr Lennard commented: ‘Our research demonstrates that statistically, having a mastectomy does not improve the chances of surviving breast cancer after a false-negative scan. We have reviewed the advice we give to patients as a result of these findings and I would have thought it sensible for specialists elsewhere to consider doing the same. ‘The Newcastle women were all given the choice of mastectomy or breast conserving surgery. Those studied who chose the latter seem not to have been disadvantaged by this.’
Palpable breast cancer which is mammographically invisible. The Breast 10 (5) 416-420 (2001). The full article can be found at the web address http://www.idealibrary.com/links/toc/brst
1. Newcastle University Medical School is recognised as the UK’s centre of excellence for the teaching of medicine. It hosts the Learning and Teaching Support Network for Medicine, a network established by the UK Government to encourage best practice among medical schools and teaching hospitals.
2. It is not possible to provide the media with ‘case studies’ from this research, since all 40 women taking part were deliberately anonimised to protect their identities and the confidentiality of their medical records.