Skip to main content

Advertisement

SpringerLink
Log in

Breast-Conserving Surgery Versus Mastectomy for Survival from Breast Cancer: the Western Australian Experience

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The focus of this study was the relative survival rates of breast cancer patients whose treatment was breast-conserving surgery compared with that of mastectomy, adjusting for tumor size and nodal status because these factors may be intrinsically associated with mastectomy being the treatment of choice. Patient age was also accounted for in the model. By adjusting for these factors, we mitigate them as confounders of treatment choice in assessing effects on survival rates.

Methods

Data were sourced from linked administrative data from the Western Australian Department of Health Record Linkage Unit. The data consisted of linked records containing the diagnosis, subsequent hospital admission, and death records of about 3000 women diagnosed with cancer in Western Australia between 1 January 1995 and 31 December 1999. Cox proportional hazards regression was used to investigate survival outcomes of breast-conserving surgery compared with that of mastectomy, adjusting for tumor size, nodal status, and subject age.

Results

The hazard of death is reduced by a factor of about one half for subjects whose treatment was breast-conserving surgery over treatment by mastectomy. Furthermore, the hazard of death increases substantially for subjects with nodal involvement over subjects for whom there has been no identified spread to regional lymph nodes. Hazard of death increases as both age and tumor size increase.

Conclusions

Western Australian breast cancer patients treated with breast-conserving surgery have improved survival outcomes over those treated with mastectomy, after allowing for tumor size, patient age, and lymph node involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.

Similar content being viewed by others

References

  1. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 1985; 312:665–673

    Article  Google Scholar 

  2. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomised clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1994; 320:822–828

    Article  Google Scholar 

  3. Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332:907–911

    Article  PubMed  CAS  Google Scholar 

  4. Ismail J, Proschan MA. Randomised trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol 2005; 28:289–294

    Article  Google Scholar 

  5. Lee-Feldstein A, Anton-Culver H, Feldstein PJ. Treatment differences and other prognostic factors related to breast cancer survival. Delivery systems and medical outcomes. JAMA 1994; 271:1163–1168

    Article  PubMed  CAS  Google Scholar 

  6. Winchester DJ, Menck HR, Winchester DP. The National Cancer Database report on the results of a large nonrandomised comparison of breast preservation and modified radical mastectomy. Cancer 1997; 80:162–167

    Article  PubMed  CAS  Google Scholar 

  7. Spilsbury K, Semmens JB, Saunders CM, Holman CDJ. Long-term survival outcomes following breast cancer surgery in Western Australia. ANZ J Surg 2005; 75:625–630

    Article  PubMed  Google Scholar 

  8. O’Neill TJ, Tallis GM, Leppard P. A review of the technical features of breast cancer screening illustrated by a specific model using South Australian cancer registry data. Stat Methods Med Res 1995; 4:55–72

    PubMed  CAS  Google Scholar 

  9. Michaelson JS, Silverstein M, Wyatt J, et al. Predicting the survival of patients with breast carcinoma using tumor size. Cancer 2002; 95:713–723

    Article  PubMed  Google Scholar 

  10. Fisher ER, Anderson S, Tan-Chui E, et al. Fifteen-year prognostic discriminates for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol-06. Cancer 2001; 91:1679–687

    Article  PubMed  CAS  Google Scholar 

  11. Hastie TJ, Tibshirani RJ. Generalized Additive Models. London: Chapman and Hall, 1990

  12. Foo CS, Su D, Chong CK, et al. Breast cancer in young Asian women: study on survival. ANZ J Surg 2005; 75:566–572

    Google Scholar 

  13. Jayasinghe UW, Taylor R, Boyages J. Is age at diagnosis an independent prognostic factor for survival following breast cancer? ANZ J Surg 2005; 75:762–767

    Article  PubMed  Google Scholar 

  14. Cox DR. Regression models and life tables. J R Stat Soc B 1972; 34:187–220

    Google Scholar 

  15. S-PLUS v6.1. Seattle, WA: Insightful Corp., 2002. Available at http://www.insightful.com

  16. Therneau TM, Grambsch PM. Modelling Survival Data: Extending the Cox Model. New York: Springer-Verlag, 2000

    Google Scholar 

  17. Grambsch PM, Therneau TM, Fleming TR. Diagnostic plots to reveal functional form for covariates in multiplicative intensity models. Biometrics 1995; 51:1469–1482.

    Article  PubMed  CAS  Google Scholar 

  18. Furnival C. Access to breast-conserving treatment: are surgeons responsible? ANZ J Surg 2004; 74:402–403

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Finance and Applied Statistics, Australian National University, Canberra, Australian Capital Territory, 0200, Australia

    Michael A. Martin BSc, PhD, Ramona Meyricke BSc, Terry O’Neill BSc, MS, PhD & Steven Roberts BEc, MS, PhD

Authors
  1. Michael A. Martin BSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramona Meyricke BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Terry O’Neill BSc, MS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Roberts BEc, MS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Martin BSc, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martin, M.A., Meyricke, R., O’Neill, T. et al. Breast-Conserving Surgery Versus Mastectomy for Survival from Breast Cancer: the Western Australian Experience. Ann Surg Oncol 14, 157–164 (2007). https://doi.org/10.1245/s10434-006-9203-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9203-9

Keywords

Search

Navigation