Comparing Survival Differences between Patients Undergoing Breast-Conserving Therapy Versus Total Mastectomy as a...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Evaluating trends in total mastectomy (TM) rates for early-stage breast cancer (BC).
• Comparing survival outcomes between breast-conserving therapy (BCT) and TM.
• Assessing trends in surgical management for early-stage BC.

Purpose of the Study:

• To evaluate trends in total mastectomy (TM) rates in early-stage breast cancer (BC) patients.
• To compare overall survival (OS), distant metastasis-free survival (DMFS), local-regional recurrence (LRR), and breast cancer-specific survival (BCSS) between BCT and TM.
• To analyze survival differences based on surgical approach and patient characteristics.

Main Methods:

• Retrospective analysis of 8967 women with early-stage BC undergoing upfront surgery (2000-2014).
• Evaluation of TM rates and survival outcomes using inverse probability weighting (IPW) for confounding adjustment.
• Subset analyses based on disease stage and hormone receptor status.

Main Results:

• TM rates increased in patients aged ≤ 50 years (39.7% to 59.9%).
• After IPW adjustment, BCT with radiation showed similar OS, DMFS, and LRR but slightly worse BCSS compared to TM alone.
• No significant survival differences were observed between TM without radiation and BCT in subset analyses. BCT showed lower LRR in triple-negative, stage I BC.

Conclusions:

• Breast-conserving therapy (BCT) and total mastectomy (TM) are equivalent initial surgical strategies for early-stage breast cancer.
• These findings support shared decision-making between physicians and patients regarding surgical options.
• The study provides evidence to guide treatment choices for eligible breast cancer patients.