Nipple-Sparing Mastectomy as Safe as More Radical Procedures for Appropriate Patients
Mastectomies that preserve the nipple and an envelope of breast skin are as safe as more radical breast cancer operations for qualifying patient populations, according to one of the largest meta-analyses of studies involving women treated with this increasingly popular approach. Speaking at the American Society of Breast Surgeons Annual Meeting, lead researcher Lucy De La Cruz, MD, of the University of Miami, discussed the statistical analysis and systematic review of 19 studies published from 2004 to 2015 involving 5,393 patients, with 2,013 of these receiving nipple-sparing mastectomies.
Dr. De La Cruz noted an increasing trend toward nipple-sparing mastectomy compared with operations that remove the nipple-areolar complex. They include both skin-sparing mastectomies that leave approximately 80% of a woman’s breast skin intact and modified radical mastectomies that remove the entire breast. Current concerns exist about nipple-sparing mastectomy leaving residual glandular tissue in the nipple area, potentially leading to recurrent or new cancers. However, nipple-sparing mastectomy offers benefits of improved cosmesis and nipple sensation, often leading to enhanced self-image, compared with operations that remove the nipple-areolar complex.
Dr. De La Cruz’s research focused on 8 studies including 4,663 patients involving comparison arms with skin-sparing mastectomy and modified radical mastectomy, as well as 11 single-arm nipple-sparing mastectomy studies involving 2,013 women included in the systematic review.
Study Confirms Safety of Procedure
In the comparison arm studies, 1,398 (29.9%) women underwent nipple-sparing mastectomy, 698 (15%) received skin-sparing mastectomy and 2,567 (55.1%) were treated with modified radical mastectomy. Five of these studies compared overall survival and found a 2.5% greater survival among nipple-sparing mastectomy patients. Three studies compared disease-free survival and demonstrated a 4.4% difference favoring nipple-sparing mastectomy. All eight studies examined local tumor recurrence and found a consistent rate among all treatment groups.
“Our hypothesis was that in the setting of breast cancer, nipple-sparing mastectomy is as safe as skin-sparing mastectomy and modified radical mastectomy,” commented Dr. De La Cruz. “The data clearly support this. We believe that the small benefit shown for nipple-sparing mastectomy in the study should be taken very lightly.”
Nineteen studies provided data on nipple-areolar tumor recurrence for a total of 1,861 patients. For 547 patients followed for less than 3 years, the recurrence rate was 0.6%, whereas the 456 followed for 3 to 5 years showed a 0.5% recurrence, and the 1,032 followed for more than 5 years had a 2.1% recurrence rate.
Dr. De La Cruz noted that most women across all studies had stage I or II invasive ductal carcinoma. The final meta-analysis excluded all women receiving prophylactic mastectomies.
“To amass a more statistically valid sampling, a meta-analysis looks at the findings of multiple studies which often involve a limited number of subjects at a single institution. Alternatively, prospective cancer registries such as the American Society of Breast Surgeons’ Nipple Sparing Mastectomy Registry are also extremely important to further rigorous scientific research on procedures such as this to benefit women in the future.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
