Mastectomy not always best to treat breast cancer early, researchers say
In some cases women would have been better off having lumpectomy rather than having breast removed, study claims
Up to 200 British women diagnosed with an early form of breast cancer each year might be undergoing mastectomies because of failures in managing treatment, researchers have suggested.
Failures by radiologists or pathologists to accurately measure the disease, lack of communication between specialist hospital teams and the patients' choice of surgical procedure mean women are not getting the optimum treatment.
In some cases, women would have been better off having a lumpectomy – known as breast conservation surgery – rather than having their breast removed, according to a study into how hospitals treat ductal carcinoma in situ (DCIS), in which cells in some milk ducts have started to turn into cancer cells but have not generally spread to surrounding breast tissue.
In as many as one in five cases detected through the NHS's breast screening programme over nine years, mastectomies were either carried out for tumours less than 20mm wide, a size for which lumpectomy is usually the best procedure, or were needed because lumpectomy had failed after underestimation of the size of tumour.
About one in 10 cases of all 30,000 breast cancer cases detected each year are DCIS, most through screening.
The disease can be hard to identify because the cells do not necessarily form one clear delineated lump. But there appeared to be wide variations between hospitals involved in the study suggesting many of the problems arose because of the quality of assessments made by multidisciplinary teams including surgeons, oncologists and nurses as well as pathologist and radiologists. The researchers, from the Sloane Project, which provides UK-wide cancer audits, believe this may be more down to variation in practice rather than variation among patients.
Jeremy Thomas, consultant pathologist at the Western General hospital, Edinburgh, extrapolated findings for the Guardian after giving the results of the study to the European Breast Cancer Conference in Glasgow. "The initial figures show the NHS breast cancer screening programme is working well and that the right surgical decisions are being made in the majority of cases," he said. "However, the significant variation between hospitals shows that we can do better."
Patient choice was also probably a factor. Women undergoing mastectomy usually did not require radiotherapy and there may be social reasons too for their choice. For instance, a woman caring for a relative might find it inconvenient to attend regular radiotherapy.
"It is quite a complicated issue but most people agree we could probably improve."
The study results will be published soon in the European Journal of Cancer.
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