Posted online May 15, 2006 on www.jco.org 
A new analysis shows that women with metastatic breast cancer (cancer that has spread beyond the breast to other parts of the body) at initial diagnosis were 40% more likely to survive at least five years if they underwent surgery to remove the primary tumor. Currently, patients who are diagnosed with metastatic breast cancer at initial diagnosis do not undergo surgery and generally receive palliative care. The study-which will be published online May 15 in the Journal of Clinical Oncology- suggests the need to re-evaluate the current standard of care for women with metastatic disease at initial diagnosis.
The study was conducted by researchers at the Geneva Cancer Registry at the University of Geneva, Switzerland, who looked at all cases of breast cancer diagnosed in Geneva since 1970. Of these, 300 women had metastatic disease when they were first diagnosed with breast cancer. Just over half of the women received no surgery for the primary tumor while the other half underwent either mastectomy (removal of the entire breast) or tumorectomy (removal of the cancerous tissue).
The researchers found that women who underwent surgery and had no remaining cancer cells in the surrounding tissue ("negative surgical margins") were 40% more likely to be alive five years after diagnosis than women who did not have surgery. The five-year survival rate for women who had negative surgical margins was 27%, compared with 16% for women with surgery and positive margins (where the tissue surrounding the tumor was found to be cancerous) and 12% for women who did not undergo surgery at all.
The most common sites for breast cancer metastasis include the bone, the brain, and the liver. In this analysis, researchers found that the improved survival effect was particularly evident among women whose cancer had spread only to the bone. Among women whose cancer had spread only to the bone at initial diagnosis, those who underwent surgery and had negative surgical margins were 80% more likely to be alive five years following surgery than women who did not have surgery.
The researchers stressed the need to conduct a large-scale clinical trial to determine whether surgery should become the standard of care for women who have metastatic breast cancer at initial diagnosis.
What Does This Mean for Patients?
This study provides hope to women diagnosed with metastatic breast cancer at initial diagnosis, showing that surgery may improve survival. Women who are diagnosed with metastatic breast cancer should talk to their doctor about potential treatment options, including whether surgery for the primary tumor would be a beneficial option.