Saving Breasts after Cancer Treatment

(Ivanhoe Newswire) – Improvements in breast cancer treatments are making it possible for more women to save their breasts following therapy, but this raises concerns about whether enough women are being offered these treatments.

Dr. Carmen Criscitiello, from the European Institute of Oncology in Milan, Italy, and colleagues conducted an analysis of different factors that can lead to choice of surgery offered to patients in the NeoALTTO trial. The NeoALTTO trial showed that the combination of paclitaxel, lapatinib and trastuzumab significantly increased the rate of tumor eradication (pathological complete response) compared to paclitaxel combined with either drug alone. They found that despite this high rate of response, the proportion of women receiving breast-conserving surgery remained around 40%, regardless of which treatment the 429 women in the study received.

"The experimental treatment with paclitaxel plus lapatinib and trastuzumab within the NeoALTTO trial nearly doubled the rate of pathological complete response compared to treatment with paclitaxel combined with either drug alone," Dr. Criscitiello was quoted as saying. "However, this successful result did not translate into a higher rate of breast preserving surgery. Indeed, we saw that tumor characteristics prior to neoadjuvant therapy play a main role in deciding the type of surgery, irrespective of the response to given therapies." Dr. Criscitiello and colleagues call for a clear consensus in the role of breast conserving surgery for patients responding to neoadjuvant therapy.

Dr. Indrajit N Fernando from University Hospitals Birmingham NHS Foundation Trust and colleagues also found that treating women with early breast cancer using chemotherapy and radiotherapy at the same time reduces the risk of recurrence, without having a negative impact on breast appearance.

Researchers took breast photographs of 301 women who underwent breast surgery in the study, and asked them about their own perceptions before surgery and 1, 2 and 5 years after surgery. The women included in this analysis were a subset of patients from a trial of 2296 women randomized to receive either sequential or synchronous chemo-radiation.

Their aim was to study cosmesis --the overall aesthetic appearance of the breasts-- and telangiectasia, the appearance of small red blood vessels on the surface of the skin. "There was no significant difference in cosmesis or telangiectasia between the two arms as assessed by the clinician or by independent photographic review. There was no difference in patient perception of breast appearance," they report.

Source: European Society for Medical Oncology 2012 Congress in Vienna, Austria, October 2012