American women with an early, noninvasive stage of breast cancer are increasingly opting for less extensive surgery, a new study says.
But there was one exception to the trend: The number of patients who decide to have both breasts removed is growing, even though this method doesn’t improve survival, according to the researchers.
The study focused on what’s known as ductal carcinoma in situ — a very early stage of breast cancer that indicates the presence of noninvasive, yet potentially early cancer cells.
“With this analysis, we sought to determine what treatment women selected when diagnosed with [ductal carcinoma in situ], and whether there was any impact in mortality with the different treatments,” said study senior author Dr. Shelley Hwang, chief of breast surgery at Duke Cancer Institute in Durham, N.C.
The researchers analyzed data from more than 121,000 cases of ductal carcinoma in situ diagnosed nationwide between 1991 and 2010.
In general, less aggressive treatment became more common during the study period. Rates of single breast removal (mastectomy) fell from about 45 percent to 19 percent, while rates of lumpectomy and radiation rose from about 24 percent to nearly 47 percent.
The study also found that less invasive sentinel node biopsies became more common in place of removing numerous lymph nodes.
However, removal of both breasts (double mastectomy) rose from 0 percent to 8.5 percent, often among younger patients, according to the findings published recently in the Journal of the National Cancer Institute.
After 10 years, overall survival rates were highest for women who had lumpectomy with radiation (about 90 percent), followed by mastectomy (86 percent) and lumpectomy alone (nearly 81 percent).
But when researchers looked specifically at breast cancer deaths over 10 years, they found that survival rates were nearly identical, at about 98 percent, for all treatment methods.
The researchers followed women after they were diagnosed with ductal carcinoma in situ. “Overall, 9.2 percent of all deaths were due to breast cancer. However, the predominant cause of death was not breast cancer, but cardiovascular disease, which accounted for 33 percent of all deaths,” Hwang said in a Duke news release.
The exception was among women younger than 50 with ductal carcinoma, where one-third of deaths were due to breast cancer. That highlights the need for these younger patients to receive more aggressive treatment, Hwang believes.
“This is an important women’s health issue, and we still do not have enough data around what the best treatment is,” she added. “Studies like ours should be viewed as a call for well-designed clinical trials that could provide more information to better guide both doctors and patients.”
The American Cancer Society has more about breast cancer.