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BREAST-CANCER THERAPIES PASS THE TEST OF TIME

Long follow-up studies of breast cancer patients confirm the lasting benefits of two strategies that have become commonplace - combining chemotherapy with mastectomy, and removing just the lump.

While now standard practice, both lumpectomy and chemotherapy were once controversial. Some doctors argued that it would take a decade or two to learn if the new approaches were truly helpful. Now enough time has passed for an assessment of the long-term effects."These data should be reassuring to the many patients with cancer who believe that a diagnosis of breast cancer is a death sentence," Dr. I. Craig Henderson of the University of California at San Francisco wrote in an editorial accompanying two follow-up studies in Thursday's issue of the New England Journal of Medicine.

Until about 25 years ago, breast cancer was treated solely with mastectomy, or complete removal of the cancerous breast. In the 1970s, however, doctors came to believe that adding chemotherapy could improve the survival rate of women whose cancer had spread to their lymph nodes.

During the 1980s, studies suggested that a mastectomy was not always necessary. In women with early breast cancer, it appeared that cutting out only the cancerous lump was just as effective.

Dr. Gianni Bonadonna and others from the National Tumor Institute in Milan, Italy, reported on 386 women who had mastectomies for breast cancer that had spread to their lymph nodes.

After 20 years of follow-up, 34 percent of those receiving chemotherapy were still alive, compared with 25 percent of the women who got surgery alone. The survival advantage was greatest in younger patients, who probably received higher doses of chemotherapy.

The other study, conducted by Dr. Joan A. Jacobson and others from the National Cancer Institute, looked at 237 women who received either lumpectomy or mastectomy for small early-stage tumors.

After 10 years, survival was virtually identical. About 75 percent were still alive in both treatment groups.

These researchers concluded that since both mastectomy and lumpectomy are excellent approaches, it is up to the patient to choose.