Our Summary

This study looked at patients who had a type of breast cancer surgery known as lumpectomy for a second time, without undergoing radiation therapy after the surgery. The researchers were particularly interested in understanding the risk of the cancer coming back in the same breast (a condition known as ipsilateral breast tumor recurrence, or IBTR). They studied 65 patients, and found that after about 5 years, 83% of these patients did not experience a second recurrence of cancer in the same breast.

They also found that the type of breast cancer (as determined by the presence of certain proteins, the estrogen receptor and HER2) was an important factor in predicting whether the cancer would come back. Specifically, patients with cancer that was positive for the estrogen receptor but negative for HER2 had a better chance of remaining cancer-free in that breast (88% remained cancer-free after 5 years compared to 75% for other types).

Further analysis showed that the type of breast cancer and the status of the margins at the original surgery (how close the cancer was to the edge of the tissue removed) could identify a group of patients with a low risk of the cancer coming back in the same breast. In fact, all of the patients in this low-risk group remained cancer-free in that breast for 5 years. The researchers conclude that for these low-risk patients, having a second lumpectomy without radiation therapy could be a safe treatment option.

FAQs

  1. What is the risk of local recurrence in patients who undergo repeat lumpectomy without radiotherapy after salvage surgery for ipsilateral breast tumor recurrence (IBTR)?
  2. How does the breast cancer subtype of IBTR, specifically the estrogen receptor (ER) and HER2 status, impact the risk of second IBTR?
  3. Who are considered as low-risk patients for second IBTR and how can they safely undergo repeat lumpectomy without radiotherapy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumpectomy is to discuss with their healthcare provider the potential benefits and risks of repeat lumpectomy without radiotherapy for ipsilateral breast tumor recurrence. It is important to consider factors such as the subtype of breast cancer and margin status of the primary surgery to determine the appropriate course of treatment. Patients in a low-risk group may be able to safely undergo repeat lumpectomy without radiotherapy. It is essential to have open communication with your healthcare team to make informed decisions about your treatment plan.

Suitable For

Patients who are typically recommended lumpectomy are those with early-stage breast cancer, particularly those with small tumors that have not spread to the surrounding breast tissue. Lumpectomy is often recommended for patients with ductal carcinoma in situ (DCIS) or invasive breast cancer, as well as for patients who have had a lumpectomy in the past and are experiencing ipsilateral breast tumor recurrence (IBTR).

In particular, patients with the estrogen receptor (ER)-positive/HER2-negative subtype of IBTR may be good candidates for lumpectomy without radiotherapy after salvage surgery. These patients have been shown to have a significantly better second IBTR-free survival rate compared to those with other subtypes of IBTR. Additionally, patients who are in a low-risk group defined by the breast cancer subtype of IBTR and margin status of primary surgery may also be good candidates for repeat lumpectomy without radiotherapy for IBTR.

Overall, lumpectomy may be recommended for patients who have small, early-stage tumors that have not spread, and who are suitable candidates for breast-conserving treatment. It is important for patients to discuss their individual situation and treatment options with their healthcare provider to determine the best course of action for their specific case.

Timeline

Before lumpectomy:

  1. Patient may notice a new lump or change in their breast during a self-exam or through imaging tests.
  2. Patient may undergo a biopsy to confirm the presence of cancer.
  3. Oncologist will discuss treatment options, including lumpectomy, with the patient.
  4. Patient may undergo pre-operative tests and preparations for surgery.

After lumpectomy:

  1. Patient will have a follow-up appointment with their surgeon to discuss the results of the lumpectomy.
  2. Patient may undergo further treatment such as radiation therapy or hormone therapy, depending on the characteristics of the tumor.
  3. Patient will be monitored closely for any signs of recurrence through regular follow-up appointments and imaging tests.
  4. If a second ipsilateral breast tumor recurrence (IBTR) occurs, patient may undergo repeat lumpectomy without radiotherapy, depending on the risk factors identified.
  5. Patients in the low-risk group defined by the breast cancer subtype of IBTR and margin status of primary surgery could safely undergo repeat lumpectomy without radiotherapy for IBTR.

What to Ask Your Doctor

  1. What is a lumpectomy and how does it differ from a mastectomy?
  2. Am I a candidate for a lumpectomy or would a mastectomy be more appropriate for my situation?
  3. What are the potential risks and complications associated with a lumpectomy?
  4. Will I need additional treatments such as radiation therapy after the lumpectomy?
  5. How will the lumpectomy affect the appearance and function of my breast?
  6. What is the likelihood of the cancer recurring after a lumpectomy?
  7. Are there any specific factors, such as the subtype of breast cancer, that may affect my risk of recurrence after a lumpectomy?
  8. How often will I need follow-up appointments and monitoring after the lumpectomy?
  9. Are there any lifestyle changes or precautions I should take after the lumpectomy to reduce my risk of recurrence?
  10. Are there any clinical trials or new treatments that I should consider in addition to the lumpectomy?

Reference

Authors: Ishitobi M, Fukui R, Hashimoto Y, Kittaka N, Nakayama T, Tamaki Y. Journal: Anticancer Res. 2017 Sep;37(9):5293-5299. doi: 10.21873/anticanres.11955. PMID: 28870967