A University of Iowa study that included more than 21,000 women with stage IV breast cancer finds that survival has improved over the past two and a half decades and is increasingly of prolonged duration, particularly for some women undergoing initial breast surgery. The findings were published online December 2 in the journal JAMA Surgery.
Stage IV breast cancer is generally considered incurable, and treatments focus on controlling symptoms and improving length and quality of life. In recent decades, the overall medical view has been that removing the primary tumor will not benefit the patient once the disease has spread throughout the body, but there is evidence that removing primary tumors can prolong survival in some other types of advanced cancer.
Spurred by the observation that a small but growing number of her patients with stage IV breast cancer were living a long time without disease progression, Dr. Alexandra Thomas, professor of internal medicine in the UI Carver College of Medicine and co-leader of Holden Comprehensive Cancer Center’s Breast Molecular Oncology Group, teamed up with Dr. Mary Schroeder, assistant professor of health services research in the UI College of Pharmacy, to investigate whether receiving surgery to remove primary tumors is associated with improved survival for patients with stage IV breast cancer.
In addition to Drs. Thomas and Schroeder, the team included Dr. Elizabeth Chrischilles, professor of epidemiology and Marvin A. and Rose Lee Pomerantz Chair in the UI College of Public Health, and Dr. Seema Khan, professor of surgery and Bluhm Family Professor of Cancer Research at Northwestern University’s Feinberg School of Medicine.
The research team used patient data from the Surveillance, Epidemiology, and End Results (SEER) program to study 21,372 female patients diagnosed with stage IV breast cancer between 1988 and 2011 who did not receive radiation therapy as part of their first course of treatment. The researchers analyzed differences in patient survival, particularly survival of at least 10 years, between women who had initial surgery on the primary tumor and women who did not have initial surgery.
Overall, the researchers found that median survival increased from 20 months (in 1988 to 1991) to 26 months (in 2007 to 2011). Although the rate of surgery declined during this time period (from 67.8 percent in 1988 to 25.1 percent in 2011), the study showed that receiving surgery to remove the primary tumor was associated with improved survival. For women diagnosed as having cancer before 2002 (7,504 of the women in the study), survival of at least 10 years was seen in 9.6 percent of those who did receive surgery, compared with 2.9 percent of those who did not receive surgery.
“Our study in this observational data set doesn’t suggest that every patient with stage IV breast cancer should undergo surgery, but we showed that for some patients, surgery was associated with prolonged survival,” Thomas says.
This release was adapted from a news release issued by JAMA.