Pam Harrison

May 01, 2015

Nipple-sparing mastectomy (NSM) is as oncologically safe as skin-sparing mastectomies (SSMs) or modified radical mastectomies (MRMs) in carefully selected women with early-stage breast cancer, a meta-analysis concludes.

The findings were presented at the American Society of Breast Surgeons (ASBS) 16th Annual Meeting, in Orlando, Florida, and were highlighted at a press briefing.

Lucy De La Cruz, MD, University of Miami Miller School of Medicine, in Florida, reviewed 19 studies that included 5276 patients who had undergone either an NSM, an SSM, or an MRM.

Six studies compared overall survival (OS) in women undergoing an NSM vs either an SSM or an MRM.

On the basis of the results from these 6 studies, there was a 2.5 risk difference in OS in favor of the NSM compared with the other two procedures.

Three studies compared disease-free survival (DFS) in women who had undergone an NSM vs either an SSM or an MRM.

In these three studies, there was a 4.4% risk difference in DFS in favor of NSM compared with either SSM or MRM.

Nipple-Areolar Recurrence Rates

Investigators further stratified OS, DFS, and nipple-areolar recurrence (NAR) rates between women who had undergone therapeutic NSM for the treatment of cancer and those who had undergone a combined therapeutic and prophylactic NSM in which one breast did not have cancer.

Here, there were significant differences between the two groups.

  OS DFS NAR
Therapeutic mastectomy 93% 84.2% 2.6%
Combined therapeutic and prophylactic NSM 99% 96.2% 0.4%
P-value 0.006 0.012 0.001

 

"We expected that the NAR would be less among women who had the combined therapeutic and prophylactic NSM because we included breasts that didn't actually have cancer, the surgery was done either for symmetry, or patients decided they did not want to have to face the possibility of having cancer again in the future," Dr De La Cruz told Medscape Medical News during the webinar.

"But the use of prospective data registries, notably, the Nipple-Sparing Mastectomy registry, will add additional clarity over time to this important clinical question."

The same research team also systematically reviewed all 19 studies to evaluate OS, DFS, local recurrence (LR), and NAR among a total of 2011 patients.

As expected, the longer the patients were followed, the greater the differences in outcomes.

Follow-up OS (mean) DFS (mean) LR (mean) NAR (mean)
<3 years 98.6% 95.9% 3.9% 0.6%
3 - 5 years 97% 93.2% 1.2% 0.5%
>5 years 90.8% 89.9% 8.5% 2.1%

 

Commenting on the study, moderator Julie Margenthaler, MD, Siteman Cancer Center, St. Louis, Missouri, observed that in most practices in the United States, NSMs are still uncommon, although their use is increasing, especially among dedicated breast surgeons who have learned the technique.

"NSM is technically much more challenging because you have to do it through a very small incision with limited visibility," she explained.

In addition, not all women are good candidates for NSM. If a woman has a cancer, that cancer has to be a certain distance from the nipple ― generally, about 2 cm ― for the procedure to carried out safely.

"You also have to have a breast that is going to have a good cosmetic outcome," Dr Margenthaler added.

For example, women with large breasts that droop may not be good candidates for NSM because the cosmetic results will be disappointing.

American Society of Breast Surgeons (ASBS) 16th Annual Meeting. Presented April 30, 2015.

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