Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“Survival Advantage of Breast Conservation Over Mastectomy Following Neoadjuvant Chemotherapy in Clinically Node-Positive and >40-Year-Old Breast Cancer Patients
A new study reports that breast-conserving surgery (BCS) following neoadjuvant chemotherapy is associated with a significant overall survival advantage compared with mastectomy, particularly in:
- patients with clinically positive lymph nodes
- patients aged > 40 years
These findings are clinically important, as they challenge the persistent perception that more extensive surgery translates into superior oncological outcomes after systemic therapy.
Importantly, this study does not represent an isolated observation. It adds to a growing and consistent body of evidence demonstrating that breast-conserving surgery is associated with improved overall survival compared with mastectomy across multiple clinical contexts, including:
• early invasive breast cancer
• ductal carcinoma in situ (DCIS)
• ipsilateral breast tumour recurrence
• multicentric disease
• a broad range of molecular subtypes
Collectively, these data reinforce a clear message: when technically feasible and combined with appropriate radiotherapy and systemic treatment, breast-conserving surgery is not only oncologically safe, but may confer a survival advantage across diverse breast cancer scenarios.
In appropriately selected patients receiving optimal radiotherapy and systemic therapy, mastectomy may represent a liability rather than an advantage for overall survival.
Surgeons and oncologists must be fully aware of this evolving evidence, and contemporary clinical guidelines should be urgently re-evaluated and updated to reflect these consistent survival signals. Surgical decision-making should prioritise outcomes, biology, and evidence, rather than historical dogma or procedural maximalism.”
Title: Comparison of overall survival and disease-free survival for breast-conserving surgery and mastectomy in breast cancer patients receiving neoadjuvant therapy: a matched case-control study from two institutions
Authors: Xueqian Du, Senyan Zhang, Yilu Li, Yue Li, Yueqing Feng
