The majority of women with multiple tumors in a single breast reported good or excellent satisfaction with the cosmetic results of lumpectomy, despite loss of significant breast volume and often multiple incisions. These findings are from an ongoing multicenter prospective trial examining the feasibility of breast-conserving surgery in this growing patient population. Rosenkranz et al presented the data as part of the American Society of Breast Surgeons (ASBrS) 2020 Scientific Session.
“Today, this patient population comprises an estimated 15% of women with breast cancer. Traditionally, they have been treated with mastectomy due to concerns about tumor recurrence and poor cosmetic outcomes with large-volume excision and radiation,” explained lead author Kari Rosenkranz, MD, of Dartmouth-Hitchcock Medical Center. “Cosmetic issues for these patients are addressed with the option of immediate breast reconstruction. However, for many women, the loss of a breast with mastectomy rather than lumpectomy leads to diminished well-being, self-image and overall quality-of-life.”
Study Methods
This trial was designed following a growing number of retrospective studies that demonstrated recurrence rates in appropriately selected patients with multiple tumors treated with breast conservation are similar to those expected in women with a single tumor. However, the cosmetic impact of this surgery has been uncertain.
Researchers focused on cosmetic data from 216 women who completed lumpectomy and radiation. All participants had two or three discreet malignancies in a single breast separated by more than 2 cm and confirmed on biopsy. Individually, each tumor met criteria for lumpectomy.
“We are hopeful that these new data on cosmesis and the future overall results regarding cancer recurrence from this trial will enhance the dialogue regarding best treatments for women with more than one site of disease in a breast and open new options for patients who desire breast preservation,”— Kari Rosenkranz, MD
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Both patients and surgeons completed surveys to rate their perceptions of cosmetic results on a 4-point scale, with 1 representing excellent and 4 representing poor results. Patients were surveyed at eight postoperative time points, beginning at 30 days and ending at 60 months. Surgeons were surveyed once at 30 days after the procedure.
In addition, patient perception was assessed with BREAST-Q, a validated self-rating tool that quantifies patient quality of life and satisfaction related to breast surgeries. BREAST-Q scores range from 1 to 100.
Reported Outcomes
On the surveys, the majority of women reported good or excellent cosmetic results. At 2 years postsurgery, 70.6% of patients scored results as good or excellent; only 3.7% of patients scored their results as poor. These ratings are similar to those treated with lumpectomy for single-site disease.
Age, the number of lesions, and the number of lumpectomies to achieve negative margins had no impact on the cosmetic results. Data remained relatively consistent across the 5-year study period, although the number of survey participants declined.
Patient BREAST-Q scores were similar, with an expected slight drop in the section of the survey measuring effects of radiation during the 6- to 12-month intervals when radiation impact is most severe.
“During recent years, diagnosis of multifocal breast disease has significantly increased as today’s more sensitive breast imaging technologies pick up more lesions than in the past,” commented Judy Boughey, MD, co–principal investigator of the trial. “As a result, today’s multifocal population is characterized by a greater number of patients with earlier-stage, less aggressive tumors. Moreover, modern targeted therapies are more effective in treating breast disease than in the past, leading to long-term survival with less invasive surgical approaches.”
“We are hopeful that these new data on cosmesis and the future overall results regarding cancer recurrence from this trial will enhance the dialogue regarding best treatments for women with more than one site of disease in a breast and open new options for patients who desire breast preservation. We believe this could greatly improve patient satisfaction and well-being,” concluded Dr. Rosenkranz.
