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For Early Cancer, Lumpectomy Beats Mastectomy for Survival: Study

Rating

3 Star

For Early Cancer, Lumpectomy Beats Mastectomy for Survival: Study

Our Review Summary

Strong point: The Independent expert perspectives added to the story.

Weaker points:  Harms not discussed.  Benefits not adequately quantified.  The true novelty of the study was not adequately explained. And why was there no mention of adjuvant chemotherapy or hormone therapy?

 

Why This Matters

Individuals diagnosed with breast cancer are in shock.  Psychologically challenged, they must then make major decisions about treatment.  Two common choices include mastectomy, or lumpectomy with radiation.  Both have major consequences, with little time to consider options. Any facts can help women and men make this decision, taking into account physical costs, psychological costs, and survival probabilities.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There was no discussion of the differences in cost between the two options.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story only attempted to quantify a benefit for one subset of women, when it reported:

“The group that benefited the most — who had the biggest difference in breast cancer survival — were those women over 50 with estrogen-receptor positive disease,” Hwang said. This means their cancer depends on estrogen to grow.

Among those women, the lumpectomy group had a 13 percent lower risk of death from breast cancer and a 19 percent lower risk of death from any cause than those who had a mastectomy.”

But that was only a subset of women.  And even in that subset, what was the risk of death? Was the difference of 13% and 19% really that much of a difference?

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There was no mention of possible harms from either treatment.  In particular, there was no mention of the possible long-term dangers of radiation.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story did turn to two independent sources to evaluate the quality of the evidence, one of whom said, “I am not sure the study convinces us that lumpectomy and radiation is better for breast cancer survival, but it may be.”

The story also pointed out that the “study was observational… It found a link or association but could not provide cause-and-effect proof that the breast-conserving treatment is more effective than mastectomy in early stage breast cancer.”

Does the story commit disease-mongering?

Satisfactory

There was no disease mongering noted.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The article did include the perspectives of two independent sources.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story didn’t say anything about adjuvant chemotherapy or hormone therapy.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

No discussion of availability of either approach, but we don’t think that was necessary in this case.

Does the story establish the true novelty of the approach?

Not Satisfactory

All the story said was that “Earlier research had also concluded that the two procedures are similarly effective, but Hwang’s is a more “real-world” study.”   But the story never adequately explained what that means and why it makes this analysis different.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story includes several independent sources.

Total Score: 4 of 9 Satisfactory

Comments (5)

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Katherine OBrien (@ihatebreastcanc)

January 29, 2013 at 10:33 pm

http://newscenter.berkeley.edu/2012/12/17/malignant-breast-cells-grow-normally-when-compressed/

Please take a look at this release–do you think the research merited a release?

No “reputable” site picked it up. However, this site offers a typical example of the release’s appeal: http://ireporterstv.co/squeezing-breasts-may-cure-breast-cancer-research/

Here’s a “tamer” version: http://kzok.cbslocal.com/2012/12/20/breast-squeezing-is-a-win-win/

Classy! But again, I wonder why a release was issued. Is there any news here????

Reply

m stewart

February 1, 2013 at 8:42 pm

This is a ricuculous statement…So they are saying results are better if you remove only the lump with radiation as opposed to the whole breast. What about stray cells that may not have been removed by the lumpectomy? Or other cancers in that breast that could develop later? No sense at all.

Reply

Pat Battaglia

February 4, 2013 at 10:41 am

m stewart, I understand your concerns. It seems counterintuitive that breast conserving surgery (lumpectomy) plus radiation therapy provides a similar outcome to mastectomy in terms of survival. But studies show just that. If you go to the article and click the link at the end to the American Cancer Society’s page, it describes just phenomenon.
The weaknesses of the above-mentioned article are highlighted well by the reviewers. This is nothing new in the world of breast cancer. But the fact is that lumpectomy and radiation are a viable option for many who are diagnosed with this disease. It’s a matter of discussing the benefits and harms of proposed treatment with your health care providers and coming to a decision you can live with.

Reply

Norman M Canter, M.D.

March 9, 2013 at 1:03 pm

When one evaluates the results of “lumpectomy” and in reviewing studies by Veronesi and Bernard Fisher, the critical factor is extent of “lumpectomy” as compared with classical studies. If the surgeon pays sufficient attention to disease free margins, and the presence or absence of in situ disease in the remaining breast, results will be predictable and satisfactory. Unfortunately, many lumpectomies are less than ideal. These problems are less likely to be present with mastectomy which has its own drawbacks and requires a separate array of skills in execution.

Reply