Breast cancer surgery guidelines are leaving thousands of women at risk of the disease returning, a major review has found.
Around one in five women who undergo treatment to remove tumours are having insufficient breast tissue removed, researchers say.
This leaves them with a much higher chance of cancer recurring in the breast or elsewhere, making it incurable. Breast cancer is the second most deadly cancer for women, causing 11,400 deaths a year.
Experts said the focus had wrongly been on the cosmetic outcome of surgery, with an over-reliance on drug breakthroughs and radiotherapy to mop up any remaining cancerous cells.
But they believe thousands of lives could be saved if between one and two millimetres of healthy surrounding tissue was removed with a tumour.
In the biggest analysis of its kind, researchers from the University of Manchester compared the outcomes of 68 studies involving 112,140 patients. The chance of the recurrence of a tumour elsewhere in the body was 25.4 per cent in patients who had cancerous tissue up to the edge of what was removed.
Around one in five women who undergo treatment to remove tumours are having insufficient breast tissue removed, researchers say, which leaves them with a much higher chance of cancer recurring in the breast or elsewhere.
But that figure fell to 8.4 per cent for those who had up to 2mm of health tissue removed as well and to 7.4 per cent for patients with a clearance of 2mm or more, according to the findings published in the British Medical Journal.
Cases of cancer returning in the breast – which raises the disease mortality rate by four times – stood at 8.8 per cent for those with less than 1mm of healthy tissue removed but at just 3.9 per cent for cases involving more than 1mm.
Professor Nigel Bundred (pictured), who led the study, said guidelines needed changing
Professor Nigel Bundred, who led the study, said guidelines needed changing. He added: ‘You have to do the surgery right in the first place. Some patients are being left with a tumour left in the breast and the assumption is that chemotherapy and radiotherapy will compensate.’
He continued: ‘We have been in an era where everybody was de-escalating breast cancer surgery saying we’ve got all these extra treatments that make the difference… well actually they don’t.
‘There’s also been this trend over the last 10 years that everybody must have reconstruction and everything just have a wonderful cosmetic result.
‘But the patients were quite clear what they wanted, first and foremost, was cure of the cancer. They can always come back and have their cosmesis improved but they want their cancer cured.’
Regulator NICE published updated guideline on the diagnosis and management of early and locally advanced breast cancer in 2018 but felt there was insufficient evidence to clearly define an optimum removal margin.
Jane Murphy at the charity Breast Cancer Now, said: ‘It’s crucial that everyone receives the treatment most effective and suitable for them to reduce the risk of cancer returning or spreading.
‘This analysis adds to what we already know about the importance of ensuring a small amount of healthy tissue surrounding the tumour is removed during breast-conserving surgery and concludes that a minimum clear margin of at least 1mm should be achieved.
‘This evidence can now be considered within current clinical practice and should be discussed as part of the patient’s treatment.’
Breast cancer is one of the most common cancers in the world and affects more than two MILLION women a year
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.
Staging means how big the cancer is and whether it has spread. Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body.
The cancerous cells are graded from low, which means a slow growth, to high, which is fast growing. High grade cancers are more likely to come back after they have first been treated.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.
What are the symptoms of breast cancer?
The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign.
The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.
How is breast cancer diagnosed?
Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. The sample can confirm or rule out cancer.
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest x-ray.
How is breast cancer treated?
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.
Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery.
Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying
Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
How successful is treatment?
The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.
The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.