Stage 4 breast cancer, where tumor cells have spread beyond the breast, is generally considered incurable, and current treatments focus on controlling metastatic disease. However, a University of Iowa study published Dec. 2, 2015, in JAMA Surgery suggests that even in the context of advanced disease, removing the primary tumor may improve survival for some women.
Using data from the Surveillance, Epidemiology, and End Results (SEER) database, the research team from Holden Comprehensive Cancer Center at the UI looked at outcomes for 21,372 women who had stage 4 breast cancer at the time of their original diagnosis (between 1988 and 2011) and who did not receive radiation therapy as part of their initial treatment. The researchers analyzed the differences in survival, particularly survival of at least 10 years, between women who had surgery to remove the primary tumor and women who did not have initial surgery.
Overall, the study found that median survival increased from 20 months (in 1988-1991) to 26 months (in 2007-2011). And, although the rate of surgery declined during this time period (from 67.8 percent in 1988 to 25.1 percent in 2011), the study showed that receiving surgery to remove the primary tumor was associated with improved survival. For women diagnosed as having cancer before 2002 (7,504 of the women in the study), survival of at least 10 years was seen in 9.6 percent of those who did receive surgery compared to 2.9 percent of those who did not receive surgery.
“Our study in this observational data set doesn’t suggest that every patient with stage 4 breast cancer should undergo surgery, but we showed that for some patients, surgery was associated with prolonged survival,” says Alexandra Thomas, MD, clinical professor of internal medicine in the UI Carver College of Medicine.