Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Jan;173(2):301-311.
doi: 10.1007/s10549-018-5007-4. Epub 2018 Oct 20.

Breast conservation versus mastectomy in patients with T3 breast cancers (> 5 cm): an analysis of 37,268 patients from the National Cancer Database

Anna M Mazor  1 , Alina M Mateo  1 , Lyudmila Demora  2 , Elin R Sigurdson  1 , Elizabeth Handorf  2 , John M Daly  1 , Allison A Aggon  1 , Penny R Anderson  3 , Stephanie E Weiss  3 , Richard J Bleicher  4
Affiliations
Comparative Study

Breast conservation versus mastectomy in patients with T3 breast cancers (> 5 cm): an analysis of 37,268 patients from the National Cancer Database

Anna M Mazor et al. Breast Cancer Res Treat. 2019 Jan.

Abstract

Purpose: Breast conservation therapy (BCT) is standard for T1-T2 tumors, but early trials excluded breast cancers > 5 cm. This study was performed to assess patterns and outcomes of BCT for T3 tumors.

Methods: We reviewed the National Cancer Database (NCDB) for noninflammatory breast cancers > 5 cm, between 2004 and 2011 who underwent BCT or mastectomy (Mtx) with nodal evaluation. Patients with skin or chest wall involvement were excluded. Patients having clinical T3 tumors were analyzed to determine outcomes based upon presentation, with those having pathologic T3 tumors, subsequently assessed, irrespective of presentation. Overall survival (OS) was analyzed using multivariable Cox proportional hazards models, with adjusted survival curves estimated using inverse probability weighting.

Results: After exclusions, 37,268 patients remained. Median age and tumor size for BCT versus Mtx were 53 versus 54 years (p < 0.001) and 6.0 versus 6.7 cm (p < 0.001), respectively. Predictors of BCT included age, race, location, facility type, year of diagnosis, tumor size, grade, histology, nodes examined and positive, and administration of chemotherapy and radiotherapy. OS was similar between Mtx and BCT (p = 0.36). This held true when neoadjuvant chemotherapy patients were excluded (p = 0.39). BCT percentages declined over time (p < 0.001), while tumor sizes remained the same (p = 0.77). Median follow-up was 51.4 months.

Conclusions: OS for patients with T3 breast cancers is similar whether patients received Mtx or BCT, confirming that tumor size should not be an absolute BCT exclusion. Declining use of BCT for tumors > 5 cm in younger patients may be accounted for by recent trends toward mastectomy.

Keywords: Breast conservation; Locally advanced breast cancer; Mastectomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: This work was supported by United States Public Health Services grant P30 CA006927 for analysis of the data via support of our biostatistics facility, and by generous private donor support from the Marlyn Fein Chapter of the Fox Chase Cancer Center Board of Associates, for analysis and interpretation of the data.

The authors otherwise have no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Cohort exclusion diagram
Figure 2.
Figure 2.
Trend in tumor size over time.
Figure 3.
Figure 3.
Unadjusted use of breast conservation over time. P for decreasing trend <0.001 for all ages; p<0.001 for ≤65, p=0.144 for >65.
Figure 4.
Figure 4.
Adjusted Overall Survival Breast Conservation vs. Mastectomy
Figure 5.
Figure 5.
Kaplan-Meier Curves for Adjusted Overall Survival of (A) Combined pT3 and cT3 cohort and (B) pT3 with NACT removed.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, McCormick B, Moran MS, O’Regan RM, Patel SA, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Sitapati A, Smith KL, Smith ML, Soliman H, Somlo G, Telli ML, Ward JH, Kumar R, Shead DA (2018) Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 16 (3):310–320. doi:10.6004/jnccn.2018.0012 - DOI - PubMed
    1. Early Breast Cancer Trialists’ Collaborative G (1995) Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 333 (22):1444–1455. doi:10.1056/NEJM199511303332202 - DOI - PubMed
    1. Bleicher RJ, Ruth K, Sigurdson ER, Ross E, Wong YN, Patel SA, Boraas M, Topham NS, Egleston BL (2012) Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol 30 (36):4485–4492. doi:10.1200/JCO.2012.41.7972 - DOI - PMC - PubMed
    1. Margolis G, Goodman RL, Rubin A (1990) Psychological effects of breast-conserving cancer treatment and mastectomy. Psychosomatics 31 (1):33–39. doi:10.1016/S0033-3182(90)72214-1 - DOI - PubMed
    1. National Accreditation Program for Breast Centers. NAPBC Standards Manual 2018 Edition (2018). In: Surgeons ACo; (ed)

Publication types

MeSH terms