Cancer patients who say No to a mastectomy 'more likely to survive'
Why? Perhaps because they were less unwell to start with and hence more confident of a less invasive procedure
Women stand a better chance of surviving breast cancer if they don’t have a mastectomy, a major study has found.
Those aged over 50 who have only the lump removed, followed by radiotherapy, are almost a fifth more likely to survive the illness than patients who lose the whole breast.
Many women diagnosed with breast cancer choose to have a mastectomy thinking it will remove the tumours as quickly as possible and give them the best chance of survival.
But the results of a ten-year research project by academics show that a less radical form of treatment – breast conservation surgery – is more effective.
It involves taking away the affected lump and then administering high doses of radiotherapy over a course of five or six weeks to ensure any remaining cancerous cells are killed.
Researchers from Duke University in North Carolina looked at the records of 112,154 women diagnosed with breast cancer between 1994 and 2004.
Around 55 per cent had breast conservation surgery and 44 per cent had a mastectomy.
The study, published in the journal Cancer, shows that women who had breast conservation surgery were 13 per cent more likely to survive the illness. But the results were even more promising in women over 50 whose survival odds were 19 per cent higher than those who had mastectomies.
It also found that women of all ages who had breast conservation surgery were a fifth less likely to die from other causes such as heart disease.
This study looked only at women diagnosed with breast cancer early – known as stages one or two. It did not include patients with advanced forms of the illness.
Experts believe radiotherapy may be far more effective at killing all cancerous cells than removing the entire breast.
Lead researcher Dr E Shelley Hwang, of the Duke Cancer Institute in North Carolina, said: ‘Our findings support the notion that less invasive treatment can provide superior survival to mastectomy in stage one or stage two breast cancer.
‘Given the recent interest in mastectomy to treat early stage breast cancers, despite the research supporting lumpectomy, our study sought to further explore outcomes of breast-conserving treatments in the general population comparing outcomes between younger and older women.’
Sally Greenbrook, senior policy officer at UK charity Breakthrough Breast Cancer, said: ‘We welcome these significant findings, as we have known for some time that lumpectomy and radiotherapy is as effective as mastectomy for some women.
‘These findings go further to suggest that lumpectomy with radiotherapy could be better than mastectomy in early stage invasive breast cancer.
‘We know, through speaking to women with breast cancer every day, how difficult it is to choose between a mastectomy and a lumpectomy.
This study provides further reassurance allowing women to be more confident when making this decision.
‘More research is needed to confirm these results, and we urge anybody concerned to speak to their surgeon so they can make an informed decision, as every choice is personal.’
Radiotherapy is given to women immediately after surgery and the course of treatment normally lasts five or six weeks. But many women are put off by the side effects which include chest pain, tiredness, lowered immune system and heart problems.
Around 50,000 women are diagnosed with breast cancer in the UK every year. One in eight women will get the disease at some point in their lifetime.
Thanks to medical advances the survival odds are far higher than other forms of cancer and 80 per cent of patients live beyond five years.
Economic analysis finds penicillin, not 'the pill', may have launched the sexual revolution
It's certainly plausible as a contributing factor but arrived a bit too early to be the main factor
The 1950s were not as prudish as they seemed on the surface, says economist Andrew Francis
The rise in risky, non-traditional sexual relations that marked the swinging '60s actually began as much as a decade earlier, during the conformist '50s, suggests an analysis recently published by the Archives of Sexual Behavior.
"It's a common assumption that the sexual revolution began with the permissive attitudes of the 1960s and the development of contraceptives like the birth control pill," notes Emory University economist Andrew Francis, who conducted the analysis. "The evidence, however, strongly indicates that the widespread use of penicillin, leading to a rapid decline in syphilis during the 1950s, is what launched the modern sexual era."
As penicillin drove down the cost of having risky sex, the population started having more of it, Francis says, comparing the phenomena to the economic law of demand: When the cost of a good falls, people buy more of the good. "People don't generally think of sexual behavior in economic terms," he says, "but it's important to do so because sexual behavior, just like other behaviors, responds to incentives."
Syphilis reached its peak in the United States in 1939, when it killed 20,000 people. "It was the AIDS of the late 1930s and early 1940s," Francis says. "Fear of catching syphilis and dying of it loomed large."
Penicillin was discovered in 1928, but it was not put into clinical use until 1941. As World War II escalated, and sexually transmitted diseases threatened the troops overseas, penicillin was found to be an effective treatment against syphilis. "The military wanted to rid the troops of STDs and all kinds of infections, so that they could keep fighting," Francis says. "That really sped up the development of penicillin as an antibiotic."
Right after the war, penicillin became a clinical staple for the general population as well. In the United States, syphilis went from a chronic, debilitating and potentially fatal disease to one that could be cured with a single dose of medicine. From 1947 to 1957, the syphilis death rate fell by 75 percent and the syphilis incidence rate fell by 95 percent. "That's a huge drop in syphilis. It's essentially a collapse," Francis says.
In order to test his theory that risky sex increased as the cost of syphilis dropped, Francis analyzed data from the 1930s through the 1970s from state and federal health agencies. Some of the data was only available on paper documents, but the Centers for Disease Control and Prevention (CDC) digitized it at the request of Francis.
For his study, Francis chose three measures of sexual behavior: The illegitimate birth ratio; the teen birth share; and the incidence of gonorrhea, a highly contagious sexually transmitted disease that tends to spread quickly. "As soon as syphilis bottoms out, in the mid- to late-1950s, you start to see dramatic increases in all three measures of risky sexual behavior," Francis says.
While many factors likely continued to fuel the sexual revolution during the 1960s and 1970s, Francis says the 1950s and the role of penicillin have been largely overlooked. "The 1950s are associated with prudish, more traditional sexual behaviors," he notes. "That may have been true for many adults, but not necessarily for young adults. It's important to recognize how reducing the fear of syphilis affected sexual behaviors."
A few physicians sounded moralistic warnings during the 1950s about the potential for penicillin to affect behavior. Spanish physician Eduardo Martinez Alonso referenced Romans 6:23, and the notion that God uses diseases to punish people, when he wrote: "The wages of sin are now negligible. One can almost sin with impunity, since the sting of sinning has been removed."
Such moralistic approaches, equating disease with sin, are counterproductive, Francis says, stressing that interventions need to focus on how individuals may respond to the cost of disease.
He found that the historical data of the syphilis epidemic parallels the contemporary AIDS epidemic. "Some studies have indicated that the development of highly active antiretroviral therapy for treating HIV may have caused some men who have sex with men to be less concerned about contracting and transmitting HIV, and more likely to engage in risky sexual behaviors," Francis says.
"Policy makers need to take into consideration behavioral responses to changes in the cost of disease, and implement strategies that are holistic and longsighted," he concludes. "To focus exclusively on the defeat of one disease can set the stage for the onset of another if preemptive measures are not taken."