A Comprehensive Review on the Surgical Landscape in Breast Cancer Management
DOI:
https://doi.org/10.47672/ajhmn.1737Keywords:
Narrative Review, Surgery, Breast Cancer, WomenAbstract
Purpose: The purpose of this narrative review is to examine the literature on the topic of breast surgery and its benefits for women with metastatic breast cancer. Breast surgery can involve either a mastectomy, which involves removing the entire breast along with lymph nodes, nipple, and areola, or a lumpectomy, which involves removing breast tissue and tumour but leaving the nipple and areola intact.
Methodology: We included any English-language study published between 2000 and 2021 that looked at the effects of breast surgery on survival or quality of life for women with metastatic breast cancer, whether it was an interventional study or an observational study. We utilised a combination of keywords like "Breast surgery," "mastectomy," "lumpectomy," "metastatic disease," "survival," "observational studies," "intervention studies," and "quality of life" to scour sources like PubMed and Embase. We considered randomised controlled trials that contrasted hormonal therapy, radiation, chemotherapy, biologic therapy, and supportive care with breast surgery alone or in combination with systemic therapy. A variety of outcomes were considered, including overall survival, quality of life, toxicity from local treatment as measured by one-month mortality, survival without progression, and survival specific to breast cancer.
Findings: The evidence from randomised controlled trials is limited and not conclusive, while observational studies do suggest that breast surgery may benefit with metastatic breast cancer. Since observational studies are prone to problems like selection bias and unmeasured confounding, it is difficult to draw any conclusions regarding the advantages of breast surgery without solid proof from RCTs.
Implications to Theory, Practice and Policy: Each woman diagnosed with metastatic breast cancer should be considered individually when deciding whether or not to undergo surgery. This should be done until results from big ongoing RCTs are available. When considering treatment options, the patient and doctor must weigh the pros and cons of each, as well as the associated costs. The current lack of strong evidence calls for more randomised controlled trials (RCTs) in both developing and developed nations, with bigger sample sizes.
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References
Alghamdi M.A, Esam M. S. (2023). Role of Surgery in Metastatic Breast Cancer: Insightsfrom a Narrative Review. Breast Cancer (Dove Med Press), 15:349-358https://doi.org/10.2147/BCTT.S405864
Babiera G.V, Rao R, Feng L. (2006). Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol.13(6):776-782. doi:10.1245/ASO.2006.03.033
Badwe R, Hawaldar R, Nair N. (2015). Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol, 16(13):1380-1388. doi:10.1016/s1470-2045(15)00135-7
Bjelic R.V, Fitzal F, Knauer M. (2020). Primary surgery versus no surgery in synchronous metastatic breast cancer: patient-reported quality-of-life outcomes of the prospective randomized multicenter ABCSG-28 positive trial. BMC Cancer, 20(1):392.doi:10.1186/s12885-020-06894-2
Cady B, Nathan N, Michaelson J, Golshan M, Smith B. (2008). Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol. 15(12):3384-3395. doi:10.1245/s10434-008-0085-x
DeSantis C.E, Fedewa S.A, Goding S. A, Kramer J.L, Smith R.A, Jemal A. (2016). Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin, 66(1):31-42. doi:10.3322/caac.21320
Ferlay J, Soerjomataram I, Dikshit R. (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136(5):E359-E86. doi:10.1002/ijc.29210
Khan SA, Zhao F, Solin LJ. (2020). A randomized Phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: a trial of the ECOG-ACRIN research group (E2108). Am J Clin Oncol. 38:LBA2-LBA2.doi:10.1200/JCO.2020.38.18_suppl.LBA2
Kim H.J, Kang E, Kim J.H. (2018). Survival benefit of surgical removal of primary tumor in patients with stage IV breast cancer. Clin Breast Cancer, e1037-44
Loeffler J.S, Wen P. (2018). Epidemiology, Clinical Manifestations, and Diagnosis of Brain Metastases. Waltham, MA: Google Scholar.
Loeffler J.S, Wen P. (2020). Overview of the Treatment of Brain Metastases. Waltham, MA:Wolters Kluwer.
Leung A.M, Vu H.N, Nguyen K.A, Thacker L.R, Bear H.D. (2010). Effects of surgical excisionOn survival of patients with stage IV breast cancer. J Surg Res, 161(1):83-88.doi:10.1016/j.jss.2008.12.030
Ly B.H, Nguyen N.P, Vinh-Hung V, Rapiti E, Vlastos G. (2010). Loco-regional treatment inmetastatic breast cancer patients: is there a survival benefit? Breast Cancer Res Treat,119(3):537-545. doi:10.1007/s10549-009-0610-z
Neuman, H. B., Morrogh, M., Gonen, M., Van Zee, K. J., Morrow, M., & King, T. A. (2010).Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumormatter?. Cancer, 116(5), 1226-1233. https://doi.org/10.1002/cncr.24873
Parks R, Derks M, Bastiaannet E, Cheung K. (2018). Breast cancer epidemiology. In: BreastCancer Management for Surgeons. Springer, 19-29.
Poscia A, Collamati A, Milovanovic S. (2017). Methodological issues in the observational studiesconducted in older population: a narrative review. Epidemiol Biostat Public Health,14(2):e12627-e.
Rapiti E, Verkooijen HM, Vlastos G. (2006). Complete excision of primary breast tumor improvessurvival of patients with metastatic breast cancer at diagnosis. J Clin Oncol, 24(18):27432749. doi:10.1200/JCO.2005.04.2226
Ruiterkamp J, Ernst M, Van de Poll-Franse L, Bosscha K, Tjan-Heijnen V, Voogd A.(2009).Surgical resection of the primary tumour is associated with improved survival in patientswith distant metastatic breast cancer at diagnosis. Eur J Surg Oncol, 35(11):1146-1151.doi:10.1016/j.ejso.2009.03.012
Ruiterkamp J, Ernst MFJ. (2011). The role of surgery in metastatic breast cancer. Eur J Cancer,47:S6-S22. doi:10.1016/S0959-8049(11)70142-3
Sales C, Paiva L, Scandiuzzi D, Anjos AC. (2011). Quality of life of breast cancer survivors: socialfunctioning. Rev Bras Cancerol, 47(3):263-272. doi:10.32635/21769745.RBC.2001v47n3.2304
Siegel R, Ma J, Zou Z, Jemal A. (2014). Cancer statistics, CA Cancer J Clin, 64(1):9-29.doi:10.3322/caac.21208
Soran A, Ozmen V, Ozbas S. (2016). A randomized controlled trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer: TurkishStudy (protocol MF07-01). Am J Clin Oncol, 34:1005.doi:10.1200/JCO.2016.34.15_suppl.1005
Thomas A, Khan SA, Chris chilles EA, Schroeder MC. (2016). Initial surgery and survival in stageIV breast cancer in the United States, 1988-2011. JAMA Surg, 151(5):424-431.doi:10.1001/jamasurg.2015.4539
Wang R, Zhu Y, Liu X, Liao X, He J, Niu L. (2019). The clinicopathological features and survival outcomes of patients with different metastatic sites in stage IV breast cancer. BMC Cancer,19(1):1091. doi:10.1186/s12885-019-6311-z
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Copyright (c) 2024 Alya Saeed Ali Khamis Alteneiji, Ali Mohamed Alsari Almheiri, Mohamed Saleh
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