The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence

Abstract 

Background

Many women with breast cancer recurrence previously treated with breast-conservation therapy desire repeat lumpectomies. We hypothesized that women undergoing mastectomy for breast cancer recurrence would show superior survival.

Methods

Patients who previously received breast-conservation therapy diagnosed with an ipsilateral breast cancer recurrence between 1988 and 2004 were identified using the Surveillance, Epidemiology, and End Results database. Univariate survival analysis was performed using the Kaplan-Meier method. Cox regression was used for multivariate analysis.

Results

Criteria for analysis were met in 747 patients. Of those, 24% underwent lumpectomy. On univariate analysis, patients undergoing lumpectomy had worse overall survival (P = .03). Five-year survival was 67% versus 78% for the lumpectomy and mastectomy groups, respectively. On multivariate analysis, mastectomy remained significantly associated with better survival with a hazard ratio of .5 (P = .003).

Conclusions

The use of lumpectomy for ipsilateral breast cancer recurrence previously treated with breast-conservation therapy should generally be discouraged.

Keywords: Breast cancer, Recurrence, Re-operation, Mastectomy, Lumpectomy, Prognosis