Abstract
Purpose
The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC).
Methods
Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the NCR. All patients underwent BCS or primary mastectomy without neoadjuvant treatment and proportions per year were calculated. Logistic regression analysis with adjustment for period, age, nodal status and tumor size was performed to determine the impact of histology on the likelihood of undergoing BCS.
Results
A total of 152,574 patients underwent surgery in the period between 1990 and 2010, of which 89 % had IDC and 11 % had ILC. In the group of IDC with pT1 and pT2 tumors combined, 54 % underwent BCS compared with 43 % of patients with ILC (p < 0.0001). The proportion of patients with IDC treated by BCS increased from 46 % in 1990 to 62 % in 2010. The BCS rate among ILC patients increased from 39 % in 1990 to 48 % in 2010. Patients with ILC were less likely to undergo BCS compared with patients with IDC (odds ratio 0.69; 95 % confidence interval 0.66–0.71).
Conclusion
The incidence of BCS for patients with IDC or ILC is rising in The Netherlands. However, the increase of BCS is less explicit in patients with ILC, with a higher chance of undergoing mastectomy compared with patients with IDC.
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References
Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;19:1143–1150.
Sakr RA, Poulet B, Kaufman GJ, Nos C, Clough KB. Clear margins for invasive lobular carcinoma: a surgical challenge. Eur J Surg Oncol. 2011;37:350–356.
Silverstein MJ, Lewinsky BS, Waisman JR, et al. Infiltrating lobular carcinoma. Is it different from infiltrating duct carcinoma? Cancer. 1994;73:1673–1677.
The World Health Organization. The World Health Organization histological typing of breast tumors: second edition. Am J Clin Pathol. 1982;78:806–816.
Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery. 1982;91:234–240.
Orvieto E, Maiorano E, Bottiglieri L, et al. Clinicopathologic characteristics of invasive lobular carcinoma of the breast. Cancer. 2008;113:1511–1520.
Pestalozzi BC, Zahrieh D, Mallon E, et al. Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast; combined results of 15 international breast cancer study group clinical trials. J Clin Oncol. 2008;26:3006–3014.
Yeatman TJ, Cantor AB, Smith TJ, et al. Tumor biology of infiltrating lobular carcinoma: implications for management. Ann Surg. 1995;222:549–559.
Kurniawan ED, Wong MH, Windle I, et al. Predictors of surgical margin status in breast-conserving surgery within a breast screening program. Ann Surg Oncol. 2008;15:2542–2549.
Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–1303.
Fortunato L, Mascaro A, Poccia I, et al. Lobular breast cancer: same survival an local control compared with ductal cancer, but should both be treated the same way? Analysis of an institutional database over a 10-year period. Ann Surg Oncol. 2012;19:1107–1114.
Peiro G, Bornstein BA, Connolly JL, et al. The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy. Breast Can Res Treat. 2000;59:49–54.
Straver ME, Rutgers EJ, Rodenhuis S, et al. The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy. Ann Surg Oncol. 2010;17:2411–2418.
Soucy G, Bélanger J, Leblanc G, et al. Surgical margins in breast-conservation operations for invasive carcinoma: does neoadjuvant chemotherapy have an impact? J Am Coll Surg. 2008;206:1116–1121.
Boughey JC, Wagner J, Garrett BJ, et al. Neoadjuvant chemotherapy in invasive lobular carcinoma may not improve rates of breast conservation. Ann Surg Oncol. 2009;16:1606–1611.
Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KG, et al. The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat. 2010;119:415–422.
Heil J, Buehler A, Golatta M, et al. Do patients with invasive lobular breast cancer benefit in terms of adequate change in surgical therapy from a supplementary preoperative breast MRI? Ann Oncol. 2012;23:98–104.
Schouten LJ, Hoppener P, van den Brandt PA, Knottnerus JA, Jager JJ. Completeness of cancer registration in Limburg, The Netherlands. Int J Epidemiol. 1993;22:369–376.
Sobin LH. International Union against Cancer TNM classification of malignant tumors. 6th ed. New York:Wiley-Liss; 2002.
Dietzel M, Baltzer PA, Vag T, et al. Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systemic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr. 2010;34:587–595.
Heil J, Bühler A, Golatta M, et al. Does a supplementary preoperative breast MRI in patients with invasive lobular breast cancer change primary and secondary surgical interventions. Ann Surg Oncol. 2011;18:2143–2149.
Miller BJ, Abbott AM, Tuttle TM. The influence of preoperative MRI on breast cancer treatment. Ann Surg Oncol. 2012;19:536–540.
Mann RM, Hoogeveen YL, Blickman JG, Boetes C. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat. 2008;107:1–14.
Houssami N, Turner R, Morrow M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg. 2013;257:249–255.
Cristofanilli M, Gonzalez-Angulo A, Sneige N, et al. Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol. 2005;23:41–48.
Tubiana-Hulin M, Stevens D, Lasry S, et al. Response to neoadjuvant chemotherapy in lobular and ductal breast carcinomas: a retrospective study on 860 patients from one institution. Ann Oncol. 2006;17:1228–1233.
Loibl S, von Minckwitz G, Raab G, et al. Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol. 2006;13:1434–1442.
Van Hoeve J, de Munck L, Otter R, de Vries J, Siesling S. Quality improvement by implementing an integrated oncological care pathway for breast cancer patients. Breast. 2014;23(4):364–370.
Liebregts ME, van Riet YE, Nieuwenhuijzen GA, Rutten HJ, Duijm LE, Voogd AC. Patterns and determinants of surgical management of screen detected breast cancer in the South-East Netherlands. Breast. 2013;22:713–717.
Van den Broek N, van der Sangen MJ, van de Poll-Franse LV, van Beek MJ, Nieuwenhuijzen GA, Voogd AC. Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer. Breast Cancer Res Treat. 2007;105:63–68.
Chung MA, Cole B, Wanebo HJ, Bland KI, Chang HR. Optimal surgical treatment of invasive lobular carcinoma of the breast. Ann Surg Oncol. 1997;4:545–550.
Holland PA, Shah A, Howel A, Baildam AD, Bundred NJ. Lobular carcinoma of the breast can be managed by breast-conserving therapy. Br J Surg. 1995;82:650–654.
Singletary SE, Patel-Parekh L, Bland KI. Treatment trends in early-stage invasive lobular carcinoma: a report from the National Cancer Data Base. Ann Surg. 2005;242:281–289.
Voogd AC, Nielsen M, Peterse JL, et al. Difference in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European Randomized Trials. J Clin Oncol. 2001;19:1688–1697.
Diepenmaat LA, van der Sangen MJ, van de Poll-Franse LV, et al. The impact of postmastectomy radiotherapy on local control in patients with invasive lobular breast cancer. Radiother Oncol. 2009;91:49–53.
Mahmood U, Hanlon AL, Koshy M, et al. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 2013;20:1436–1443.
Dragun AE, Huang B, Tucker TC, Spanos WJ. Increasing mastectomy rates among all age groups for early stage breast cancer: a 10-year study of surgical choice. Breast J. 2012;18:318–325.
Acknowledgment
This research was supported and facilitated by Stichting Heelkundig Kankeronderzoek Zuid-Nederland, the Comprehensive Cancer Centre South, and the Comprehensive Cancer Centre the Netherlands.
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The authors declare no conflicts of interest.
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Truin, W., Roumen, R.M., Siesling, S. et al. Patients with Invasive Lobular Breast Cancer Are Less Likely to Undergo Breast-Conserving Surgery: A Population Based Study in The Netherlands. Ann Surg Oncol 22, 1471–1478 (2015). https://doi.org/10.1245/s10434-014-4175-7
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DOI: https://doi.org/10.1245/s10434-014-4175-7