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For most of the
20th century, mastectomy, or removal of the breast, was the
surgery of choice for doctors treating women with breast cancer.
But two long-term
studies offer powerful confirmation that cutting out just
the lumps can save as many lives as mastectomies -- a finding
that could change the way thousands of women are treated for
the disease.
Many doctors began
to suspect in the 1980s, largely on the strength of early
data from the two studies, that in women whose tumors had
not spread, mastectomy worked no better than the less-disfiguring
procedure.
The studies --
one Italian and one American -- showed similar death rates
after 20 years for large groups of women who underwent either
mastectomies or breast-saving surgery.
By the end of the
1980s, the less-disfiguring procedure, often called a lumpectomy,
was widely accepted on an equal footing with mastectomy for
cancer that had not yet spread.
Still, breast-saving
surgery is not always offered to women who are potential candidates
for the operation. The researchers behind the latest findings
hope to change that.
The researchers
at the European Institute of Oncology in Milan split 701 women
into two groups: one got mastectomies, the other got lumpectomies
with radiation treatments. In the end, about a quarter of
each group died of breast cancer over 20 years.
The American study
of 1,851 women, backed by the government and run at the University
of Pittsburgh, also found little survival differences between
two similar groups. A third group of women who underwent lumpectomy
without radiation also survived as well as others, though
they developed recurrent cancer on the same side more often
than women who got radiation.
Breast cancer strikes
190,000 women a year and kills 40,000 of them.
About 90 percent
of women with stage I disease -- the earliest stage -- are
reasonable candidates for lumpectomy, according to Morrow.
Yet only 68 percent chose it in a 1998 survey by the American
College of Surgeons.
Many women who
could have undergone more narrow surgery have chosen mastectomies
on the theory that you ``get it out, and you're not going
to have any trouble." But the evidence clearly shows
no survival advantage for them.
The
New England Journal of Medicine October 17, 2002;347:1227-1241
TWO STUDIES morrow m [au]; fisher b [au]
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