Oncologists at the 2013 San Antonio Breast Cancer Symposium learned about several studies that will help them make decisions about the best treatments for people with metastatic breast cancer.
Surgery for Stage IV women. In the years I have participated in support groups for breast cancer, one of the questions that pops up frequently has been why a woman whose cancer has spread beyond her breast would not have a mastectomy. Almost everyone else with breast cancer has a lumpectomy or a mastectomy. It seems like this group of women whose cancer has reached the most serious stage would need to have the source of their cancer removed.
The standard answer has been stopping chemo or other systemic treatments long enough to do surgery would allow the cancer in a woman’s vital organs to have a chance to grow. There is even a school of thought that removing the original tumor somehow spurs its daughters elsewhere in the body to greater growth. So for many years surgery was not an option for women with metastatic breast cancer.
However, as women survived longer and their systemic treatments worked well enough that they were stable or showed no evidence of disease, practice began to change a bit. Some doctors decided that in those cases, a mastectomy made sense. The situation has been confusing to women with metastatic breast cancer because some were receiving surgery, and others weren’t. Women who sought a second opinion about what to do often received conflicting opinions. The research studies that oncologists base their opinions on looked at results after treatment and had different conclusions; however, the best way to compare treatments is to randomly assign patients to two treatments to see which is more effective.
Now two new randomized studies are helping to provide more information on which to base these decisions.
Researcher Rajendra Badwe, M.D., director of the Tata Memorial Hospital in Mumbai, India, led a randomized trial dividing women into two groups. In addition to chemotherapy, some women also received surgery and radiation. This is called loco-regional treatment (LRT) in medical speak.
Dr. Badwe and his team studied 350 women from 2005 to 2013. They matched the 173 women who received surgery and radiation with the 177 who did not for age, tumor characteristics, and the extent of disease’s spread. “We found that there was no difference in overall survival between those who received LRT and those who did not receive LRT,” Badwe said.
A Turkish study led by Dr. Atilla Soran found similar results. However, in that study there was a survival benefit if the breast cancer had spread to the bones.
There may still be a role for surgery or radiation for metastatic women if they have bone metastasis or if the cancer breaks through on the skin causing ulcers. The important information for you to know if you are a metastatic patient trying to decide whether to have surgery is is that it is still a complicated issue you will want to discuss carefully with your doctor, but that the evidence currently suggests that there is no need for you to lose your breast.