Lumpectomy for Multiple Ipsilateral Breast Cancer May Still Fend Against Recurrence at 5 Years Versus Mastectomy

Women with multiple ipsilateral breast cancer (more than one area of breast cancer within one breast) who undergo breast-conserving surgery with radiation may have a low local recurrence (cancer recurring in the same place or near the original cancer) rate at five years, according to recent study findings from the ALLIANCE Z11102 clinical trial.

Results from this study, which were presented at the San Antonio Breast Cancer Symposium, may demonstrate that breast-conserving surgery may be a reasonable treatment option for women with two to three ipsilateral foci. In particular, breast-conserving surgery, also known as a lumpectomy, is a procedure during which the cancer is removed while leaving as much of the normal breast as possible.

CURE® spoke with Dr. Judy C. Boughey, professor of surgery at the Mayo Clinic in Rochester, Minnesota, to learn more about multiple ipsilateral breast cancer and why breast conservation therapy may be suitable for some patients with the disease.

CURE®: Can you explain what multiple ipsilateral breast cancer is?

Boughey: Multiple ipsilateral breast cancer is when there is more than one area of breast cancer within one breast. If a patient undergoes workup and they are identified to have a breast cancer, often the mammogram, the ultrasound or the MRI may identify that there's more than one lesion within the breast.

Historically, people have used terminology like multifocal and multicentric. Multiple ipsilateral breast cancer is much more straightforward terminology, basically saying that there is more than one focus of cancer within one breast.

For this study, this required two centimeters (of) normal tissue between the two foci of disease, so this was not patients that just had one cancer and a little satellite right next to it. But who we recruited to this study were patients that had two separate sites of cancer, where historically often mastectomy would have been recommended for their management.

What factors should go into whether a patient undergoes breast-conservation therapy?

The vast majority of patients that we see in the clinic often are candidates for either breast-conserving therapy or mastectomy, so there are many, many variables that go into that decision making.

From a surgeon’s aspect, in terms of (whether) the patient a candidate for breast-conserving therapy, the big question is how large is the tumor and how large are the patient's breasts. If it's a single focus of disease, but a large focus of disease in a small breast, maybe that patient’s not a great candidate for breast-conserving therapy.

Furthermore, if you're looking at patients with multiple ipsilateral breast cancer, then you need to look at the size of each of those foci. And if you resect both of those areas of breast cancer, is there enough breast tissue remaining to make that a reasonable size and shape breast.

We look very much at the size of the tumor or the extent of the disease in ratio to the breast size. Women who have larger breasts may have more options than women who have smaller breasts. And obviously, women who have smaller sites of disease are going to be better candidates and patients that have extensive disease involvement.

And then the other factors that go into (this) is usually for breast-conserving therapy, that involves surgery and radiation. We want to make sure that patient is willing and interested in proceeding with the radiation component of therapy and doesn't have any contraindications to radiation.

It's very much a discussion of patient's preference, where they feel the most comfortable in terms of preserving their breast and having a smaller surgery with a lumpectomy and then radiation versus proceeding with a mastectomy, which has a bigger surgery and more body image changes, but resects the breast tissue and may allow that patient to avoid radiation.

That becomes much of the discussion. And its very much shared decision making and a patient-centered decision.

What are the main takeaways of your research for the patient population?

I think the real takeaway from the ALLIANCE Z11102 clinical trial is that for patients who have more than one focus of disease in the breast (i.e., two or possibly even three small foci of disease within the breast), they can consider breast conserving therapy based on the results of this study showing a low local recurrence rate with breast conservation.

For patients in the clinical practice that are diagnosed with two sets of breast cancer and are interested in conserving their breasts, this is now an option for them. They can consider their own personal preferences between breast conservation therapy and mastectomy. It gives the patients more choice essentially.

Transcription edited for clarity and conciseness.

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