Chemotherapy is frequently given to women with breast cancer after surgery to remove the main bulk of the tumour. A new Cochrane Systematic Review of existing data shows, however, that using chemotherapy to reduce the size of tumours before surgery does not compromise survival rates and enables women to retain better self-image and overall health because of the reduced impact of the surgery.
Cancer therapy depends on killing or removing cancerous cells as quickly as possible. Surgery involves either the removal of all breast tissue (mastectomy) or removal of just the tumour and immediate tissue (lumpectomy). Relative to mastectomy, lumpectomy reduces the scale of the surgery required, and improves self-image. Lumpectomy also has equal overall survival to mastectomy, however, this surgical option also results in a greater chance of the cancer reoccurring.
The longer the cancer cells are in the body, the more chance that a secondary cancer will develop. A logical approach, therefore, is to surgically remove as much of the tumour as possible as quickly as possible, and then use chemotherapy to kill any remaining cancer cells. Although this management has improved survival for women significantly over the last twenty years, this approach also requires extensive surgery which can lead to added physical and psychological difficulties for many women.
A team of Cochrane Researchers therefore set out to assess the safety of giving chemotherapy before surgery. This approach reduces the amount of tissue that has to be removed, but carries the risk that tumour cells that are not killed by the chemotherapy may spread before the tumour can be surgically removed. The review identified 14 randomised controlled trials involving a total of 5,500 women.
Compared to postoperative chemotherapy, preoperative chemotherapy reduced the number of mastectomies performed thereby enabling women to undergo less extensive surgery. Women receiving treatment before surgery were also less likely to suffer from serious infections. There were, however, no differences between the two methods in the length of time that women were disease-free after treatment.
"Our review showed a decreased number of adverse effects associated with preoperative chemotherapy," says lead researcher Mr Sven Mieog, who works at Leiden University Medical Center, in the Netherlands.
"It is important, however, to discuss with the patient the balance of breast conservative surgery between better quality of life and the slight increase in risk of local re-growth of the tumour, with the consequent need for further treatment," he adds.