| Complete Excision of
Primary Breast Tumor in
women diagnosed with a breast cancer already metastasized
Current guidelines recommend not removing the primary breast tumor in
women diagnosed with a breast cancer already metastasized and clinicians
believe that there is no survival advantage once metastases have occurred
and tumor excision may further stimulate the growth of the metastases. In our study we evaluated
the impact on survival of surgical removal of the breast tumor among 300
women with metastatic breast cancer at diagnosis registered at the Geneva
Cancer Registry during the period 1977-1996. Our results show that
operated women have a 50% reduction in breast cancer mortality compared to
women who did not have surgery. The 5-years survival was 12% in non
operated women and rises to 27% among operated women. This improvement in
survival is observed only if the entire primary tumor was removed with
free surgical margins. The effect of surgery was not different among
patients with different sites of metastasis; however, it was particularly
evident among women with only bone metastases at diagnosis. In contrast,
survival of women who had surgery with positive surgical margins was not
different from that of non-operated women. We believe that there is an important survival benefit operating patients
with metastatic breast tumour. Multicentric
randomized clinical trials are needed to re-evaluate the treatment
paradigm “no surgery of the primary tumor” in breast cancer with
metastases at diagnosis and to determine the impact of breast surgery on
outcome of these patients.
Bibliographical reference:
Elisabetta Rapiti Geneva
Cancer Registry, Institute for Social and Preventive Medicine, University
of Geneva, Switzerland
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