~ Surgery Not Verboten In Metastatic Breast Cancer

USA TODAY, 05-16-06

In roughly 6% of newly diagnosed U.S. breast cancer patients last year, the disease already had spread to a distant part of their bodies.

For years, doctors have believed that such patients, more than 12,600 a year, are incurable, so the main goal has been to prolong life and relieve or prevent symptoms.

But two medical studies in the past month suggest that some women who are newly diagnosed with metastatic breast cancer might benefit from more aggressive treatment.

Typically, only those patients with breast complications such as ulcers have surgery to remove their primary tumors.

In fact, conventional wisdom holds that surgically removing the primary tumor might actually fuel the growth of distant tumor cells.

Both new studies found that women whose primary tumors were completely removed after a diagnosis of metastatic disease were half as likely to die as those who did not have surgery.

One study, posted online Monday by the Journal of Clinical Oncology, included all 300 metastatic breast cancer patients recorded by the Geneva (Switzerland) Cancer Registry from 1977 to 1996.

The other study, posted online last month by the Annals of Surgical Oncology, focused on 224 patients treated at the University of Texas M.D. Anderson Cancer Center between 1997 and 2002.

No study has ever proven the widely held belief that removing a primary breast cancer in patients with metastatic disease stimulates tumor cells lurking elsewhere in the body, says lead author Elisabetta Rapiti, a cancer registry researcher. In other types of metastatic cancer, such as kidney, "everybody agrees to operate," Rapiti says.

Still, only a trial in which women newly diagnosed with metastatic breast cancer are randomly assigned to surgery or no surgery can confirm that cutting out the tumor -- and not some other characteristic of women who get surgery -- prolongs lives, the authors write.

"If this were a new drug that showed a 30% improvement in survival, everybody would be going nuts: We should rush this into trial," says Monica Morrow, co-author of an accompanying editorial and chair of cancer surgery at Philadelphia's Fox Chase Cancer Center.

She says she's not sure why doctors have much less enthusiasm for a randomized trial of a "very safe and very well-tolerated surgery."

In 2002, Morrow co-wrote the first paper to suggest a benefit from surgery in women diagnosed with metastatic breast cancer.

"Rushing into surgery initially is not the appropriate thing to do," Morrow cautions such women. Instead, she says, "it makes sense" to start with chemotherapy.

Only women whose tumors respond to chemo would then be surgery candidates, she says.

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