Date Published: 14 December 2005

Radiotherapy after lumpectomy saves lives

Following a lumpectomy for breast cancer, radiotherapy to the breast reduces the risk of eventually dying from the disease ? according to research published today in The Lancet.

An international team of researchers found that a woman's five-year risk of the cancer returning in or near the breast after a lumpectomy dropped from 26% to 7% if she also received radiotherapy, and the 15-year risk of dying from the disease dropped from 36% to 31%.

They carried out a worldwide overview of trials of radiotherapy and of different types of surgery, involving 40,000 women with early breast cancer, and found that for every four breast cancer recurrences avoided by radiotherapy, one death is prevented. The findings from this Cancer Research UK and Medical Research Council funded study will help doctors and patients decide on the most appropriate treatment.

Present UK guidelines on improving outcomes in breast cancer already state that radiotherapy should be regarded as standard treatment after a lumpectomy. But, as with any procedure, the treatment given depends on discussions between doctors and patients about the benefits and side effects, and may, in a minority of cases, result in non-standard treatment being offered.

The study also shows similar benefits from radiotherapy for women who had their entire breast removed but whose cancer had already spread to the armpit. The chances of the cancer coming back in or near the breast or armpit dropped from 23% to 6%, and the risk of dying from breast cancer dropped from 60% to 55%.

However, for women who had a breast removed, but whose cancer had not spread to the armpit, radiotherapy was found not to be appropriate; any benefits were slight and were outweighed by the side effects of radiotherapy. These can include permanent swelling of the arm, permanent limitation of shoulder movement and, occasionally, life-threatening diseases such as heart attack or a new cancer in the lung or opposite breast.

One of the organisers of the collaboration, Cancer Research UK epidemiologist Professor Sir Richard Peto from the University of Oxford, said:

" This study provides the first really definite evidence that, for women who've had breast-conserving surgery and for women whose cancer has spread to the armpit, radiotherapy reduces the long-term risk of dying from the disease. The improvement is small but definite and it adds to the improvements in long-term survival produced by chemotherapy and hormone therapy."

Dr Lesley Walker, Cancer Research UK's director of science information, said:

" The findings from this study will help doctors and patients with the information they need to weigh up the side effects and benefits when discussing the most appropriate treatment options."

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