Initial Surgery and Survival in Metastatic Breast Cancer

Initial Surgery and Survival in Metastatic Breast Cancer

Take-Home Message:

In some patients whose breast cancer has spread to other parts of the body when they are first diagnosed with breast cancer (those with metastatic breast cancer at diagnosis), surgery first may help them live longer. This approach may be particularly effective in women who have small breast cancers that are hormone receptor positive.



Initial Surgery and Survival in Stage IV Breast Cancer in the United States, 1988-2011

Authors: Thomas A, Khan SA et al.

Source: JAMA Surg. December 02, 2015. Doi:10.1001/jamasurg.2015.4539

An operation to remove the cancer in the breast for women with Stage IV breast cancer (breast cancer that has spread to other parts of the body) is controversial. Previous studies do not consistently show that the patients who had the surgery actually lived longer than those who did not have surgery to remove the cancer. Many Stage IV patients are managed with chemotherapy and hormone blocking therapy; they avoid surgery on the breast unless the tumor causes uncomfortable symptoms for the patient. Many women live several years without having surgery on their breast, and in general, it has been thought that since the cancer has already spread, surgery on the breast would not be helpful.

These researchers looked at 21,372 patients with Stage IV breast cancer between 1988 and 2011. In this time period, 39% of women received surgery as their first treatment, though the trend for surgery as the first treatment drastically decreased between 1988 and 2011. Women who underwent surgery had slightly longer (on average) survival (28 months) compared to those who had treatment without surgery first (19 months). Living longer was most often seen in patients who had smaller tumors in the breast, were more recently diagnosed, had tumor hormone receptor positivity and were married at the time of diagnosis. When analyzing for multiple variables, women who received surgery were 2.8 times more likely to survive at least 10 years compared to those who did not have surgery.

The authors suggest that aggressive local therapy in the form of initial breast surgery may benefit some women by eradicating a potential seed source of cancer or perhaps by helping the immune response. While chemotherapy continues to improve and prolong survival, surgery for women with favorable tumor features may benefit from initial breast surgery in Stage IV disease.