A study has reported that breast conserving treatment is not associated with increased likelihood of locoregional recurrence (recurrence in the breast, chest wall, or lymph nodes) compared to mastectomy in triple negative patients. Triple negative disease is a subtype of breast cancer that is estrogen receptor negative (ER-), progesterone receptor negative (PR-), and HER2 negative (HER2-).
The study was designed to investigate whether women with triple negative breast cancer who undergo breast conserving treatment (typically, radiotherapy) are more likely to develop a locoregional recurrence than triple negative patients who undergo mastectomy. Triple negative disease is an aggressive breast cancer subtype known to have a relatively high risk of locoregional recurrence.
The study included 1,325 women with triple negative breast cancer who underwent either breast conserving therapy or mastectomy at the M.D. Anderson Cancer Center in Houston, Texas between 1980 and 2010. A total of 651 (49%) of the women received breast conserving treatment and the other 674 (51%) had mastectomies. The women were followed for a median of 62 months.
The women who underwent mastectomy had larger tumors, a higher incidence of lymphovascular invasion (invasion of the cancer cells into the blood vessels or lymphatic channels), and greater lymph node involvement than the women who received breast conserving treatment. In other words, women in the mastectomy group had worse prognostic indicators (however, the authors took this into account when performing the lumpectomy vs. mastectomy comparison). Locoregional recurrence occurred less frequently in the breast conserving group during follow up (170 (26%) of the breast conserving group compared to 203 (30%) of the mastectomy group).
Five-year locoregional recurrence-free survival rates were also higher in the breast conserving group (76% compared to 71%), as was distant metastasis-free survival (68% compared to 54%) and overall survival (74% compared to 63%). Higher tumor stage, higher tumor grade, the presence of lymphovascular invasion, close or positive surgical margins, and use of non-anthracycline/taxane-based adjuvant chemotherapy each increased the risk of locoregional recurrence. On the other hand, age over 50 years was associated with lower risk. Type of surgery was not found to be associated with risk of locoregional recurrence.
The authors conclude that triple negative breast cancer should not be considered a contraindication for breast conservation.
Please see our article on the latest research concerning triple negative prognosis for more information.
Selected breast cancer studies
Comparison of locoregional recurrence in triple-negative and HER2-positive breast cancer subtype after breast-conserving therapy and modern systemic therapy.
Takita C, Reis IM, Miao F, LaFave KE, Gunaseelan V, Hurley J, et al. Comparison of locoregional recurrence in triple-negative and HER2-positive breast cancer subtype after breast-conserving therapy and modern systemic therapy.. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2011; 29:112-112 10.1200/jco.2011.29.27_suppl.112
Locoregional Recurrence in Patients With Triple-Negative Breast Cancer
Dragun AE, Pan J, Rai SN, Kruse B, Jain D. Locoregional Recurrence in Patients With Triple-Negative Breast Cancer. American Journal of Clinical Oncology. Ovid Technologies (Wolters Kluwer Health); 2011; 34:231-237 10.1097/coc.0b013e3181dea993
Individualized surveillance and follow-up based on breast cancer (BC) subtypes and risk of relapse in BC patients who received curative surgery.
Lee S, Park Y, Sun J, Seo J, Lee J, Nam S, et al. Individualized surveillance and follow-up based on breast cancer (BC) subtypes and risk of relapse in BC patients who received curative surgery.. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2010; 28:e11053-e11053 10.1200/jco.2010.28.15_suppl.e11053
Locoregional recurrence after breast-conserving therapy remains an independent prognostic factor even after an event free interval of 10years in early stage breast cancer
Tanis E, van de Velde C, Bartelink H, van de Vijver M, Putter H, van der Hage J. Locoregional recurrence after breast-conserving therapy remains an independent prognostic factor even after an event free interval of 10years in early stage breast cancer. European Journal of Cancer. Elsevier BV; 2012; 48:1751-1756 10.1016/j.ejca.2012.02.051