Success of Breast Conserving Surgery Is Not Diminished in Community Setting

WASHINGTON--The effectiveness of breast conservation surgery,as measured by survival of breast cancer patients, is similarto that of mastectomy in day-to-day medical practice, as wellas in randomized clinical studies, according to a report by theGeneral Accounting Office (GAO).

In its report, the GAO examined whether the results of lumpectomyand related treatment have been similar in day-to-day medicalpractice, where the quality of treatment is often less certainthan in randomized clinical trials. According to the GAO, it useda unique three-step analysis to reach its conclusions, combiningmetaanalysis, statistical analysis of records from a medical practicedatabase, and cross-design comparisons of results.

5-Year Survival Rates Similar

The data indicated that 5-year survival was similar followinglumpectomy or mastectomy both in day-to-day medical practice andin randomized studies, the GAO said in its report. Specifically,for medical practice cases, the adjusted 5-year survival rateswere 86.3% for breast conservation patients and 86.9% for mastectomypatients. These results correspond with the results of multicenterrandomized studies for breast conservation and for mastectomy,the report said.

The analyses did suggest that a minority of breast conservationpatients might have achieved slightly better results with mastectomy.These were patients for whom breast conservation therapy was relativelyunlikely to be used, because of such factors as residence in areaswhere this treatment is relatively uncommon, the GAO report said.The observed difference was not statistically significant, however.

To Obtain Copies

A free copy of the GAO study, Breast Conservation versus Mastectomy:Patient Survival in Day-to-Day Medical Practice and in RandomizedStudies (GAO/PEMD-95-9), can be obtained by writing The US GeneralAccounting Office, PO Box 6015, Gaithersburg, MD 20884-6015.