Abstract
Background
The principle objective of locoregional treatment in breast cancer is to eradicate local disease in the breast and local lymph nodes. Surgery in breast cancer provides locoregional control of the disease by resection appropriate to oncological principles, i.e. complete resection with tumour-free margins. Type and extent of breast surgery is dependent on tumour stage; beyond that and even more importantly, prognosis of an individual patient depends upon its stage at diagnosis.
Method
We reviewed the current literature, working out stage-specific survival and disease-free survival (DFS). The reported data were considered, according to stage and type of surgery, and a clear survey up to 20 years after surgery was depicted. Additionally, we assessed quality of life after breast cancer surgery.
Results
Overall survival (OS) rates after 5 years range from 93–84% in women diagnosed with stage I disease to 18% in women diagnosed with stage IV disease. In the management of stages I and II breast cancer, breast conservation with lumpectomy and radiation is a preferable alternative to mastectomy, with equivalent patient outcome. In stages III and IV breast cancer, surgery allows local control of the disease, but prognosis depends predominantly on the response to systemic treatment, as does prognosis in all breast cancer patients.
Conclusion
The reported data distributing patients outcome according to stage and surgical treatment provide a clear summary in order to estimate an individual patient’s risk.
Similar content being viewed by others
References
Arriagada R, Le MG, Rochard F, Contesso G (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14:1558–1564
Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, Mouridsen HT (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr:19–25
Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y (1989) Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320:822–828
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333:1456–1461
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong J-H, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241
van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H (2000) 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 92:1143–1150
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232
Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, Lippman ME, Lichter AS, Glatstein E, Okunieff P (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911
Gruenberger T, Gorlitzer M, Soliman T, Rudas M, Mittlboeck M, Gnant M, Reiner A, Teleky B, Seitz W, Jakesz R (1998) It is possible to omit postoperative irradiation in a highly selected group of elderly breast cancer patients. Breast Cancer Res Treat 50:37–46
Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ (2003) Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21:3357–3365
Fisher B, Dignam J, Tan-Chiu E, Anderson S, Fisher ER, Wittliff JL, Wolmark N (2001) Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. JNCI Cancer Spectrum 93:112–120
Sarrazin D, Le M, Rouesse J, Contesso G, Petit JY, Lacour J, Viguier J, Hill C (1984) Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy. Cancer 53:1209–1213
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, Gallus G, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Salvadori B, Zecchini A, Zucali R (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 305:6–11
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E (1985) Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312:665–673
Early Breast Cancer Trialists’ Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer—an overview of the randomized trials. N Engl J Med 333:1444–1456
Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, Menard C, Lippman ME, Lichter AS, Altemus RM (2003) Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 98:697–702
Jakesz R, Samonigg H, Gnant M, Kubista E, Depisch D, Kolb R, Mlineritsch B, Mischinger HJ, Menzel RC, Steindorfer P, Kwasny W, Tausch C, Stierer M, Taucher S, Seifert M, Hausmaninger H (2003) Significant increase in breast conservation in 16 years of trials conducted by the Austrian Breast & Colorectal Cancer Study Group. Ann Surg 237:556–564
Winchester DJ, Menck HR, Winchester DP (1997) The National Cancer Data Base report on the results of a large nonrandomized comparison of breast preservation and modified radical mastectomy. Cancer 80:162–167
Haagensen C, Stout A (1943) Carcinoma of the breast: criteria of inoperability. Am Surg 118:859
Sikov WM (2000) Locally advanced breast cancer. Curr Treat Options Oncol 1:228–238
Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark GM, Edge SB, Hayes DF, Hughes LL, Hutter RV, Morrow M, Page DL, Recht A, Theriault RL, Thor A, Weaver DL, Wieand HS, Greene FL (2003) Staging system for breast cancer: revisions for the 6th edition of the AJCC cancer staging manual. Surg Clin North Am 83:803–819
Woodward WA, Strom EA, Tucker SL, McNeese MD, Perkins GH, Schechter NR, Singletary SE, Theriault RL, Hortobagyi GN, Hunt KK, Buchholz TA (2003) Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol 21:3244–3248
De Lena M, Varini M, Zucali R, Rovini D, Viganotti G, Valagussa P, Veronesi U, Bonadonna G (1981) Multimodal treatment for locally advanced breast cancer. Result of chemotherapy–radiotherapy versus chemotherapy–surgery. Cancer Clin Trials 4:229–236
Jaiyesimi IA, Buzdar AU, Hortobagyi G (1992) Inflammatory breast cancer: a review. J Clin Oncol 10:1014–1024
Singletary SE, Walsh G, Vauthey JN, Curley S, Sawaya R, Weber KL, Meric F, Hortobagyi GN (2003) A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist 8:241–251
Noguchi M (2002) Therapeutic relevance of breast cancer micrometastases in sentinel lymph nodes. Br J Surg 89:1505–1515
Cochran AJ, Roberts AA, Saida T (2003) The place of lymphatic mapping and sentinel node biopsy in oncology. Int J Clin Oncol 8:139–150
Newman LA (2004) Locoregional control of breast cancer: surgical technique does matter (editorial). Ann Surg Oncol 11:11–13
Taucher S, Gnant M, Jakesz R (2003) Preventive mastectomy in patients at breast cancer risk due to genetic alterations in the BRCA1 and BRCA2 gene. Langenbecks Arch Surg 388:3–8
Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16:284–298
Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16:501–514
Wapnir IL, Cody RP, Greco RS (1999) Subtle differences in quality of life after breast cancer surgery. Ann Surg Oncol 6:359–366
Andritsch E, Goldzweig G, Samonigg H, Uziely B, Ever-Hadani P, Hoffman G, Krenn G, Baider L (2004) Changes in psychological distress of women in long-term remission from breast cancer in two different geographical settings: a randomized study. Support Care Cancer 12:10–18
Perloff M, Lesnick GJ, Korzun A, Chu F, Holland JF, Thirlwell MP, Ellison RR, Carey RW, Leone L, Weinberg V (1988) Combination chemotherapy with mastectomy or radiotherapy for stage III breast carcinoma: a cancer and leukemia group B study. J Clin Oncol 6:261–269
Buzdar AU, Singletary SE, Booser DJ, Frye DK, Wasaff B, Hortobagyi GN (1995) Combined modality treatment of stage III and inflammatory breast cancer. MD Anderson Cancer Center experience. Surg Oncol Clin N Am 4:715–734
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955
Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, Kamby C, Kjaer M, Gadeberg CC, Rasmussen BB, Blichert-Toft M, Mouridsen HT (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Taucher, S., Jakesz, R. Survival after surgical treatment of breast cancer. Langenbecks Arch Surg 389, 75–82 (2004). https://doi.org/10.1007/s00423-004-0465-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-004-0465-z