Familial sarcoma: challenging pedigrees

✍ Scribed by Justo Lorenzo Bermejo; Kari Hemminki

• Book ID: 102109033
• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 55 KB
• Volume: 100
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/cncr.20174

✦ Synopsis

Eighteen-Year Results in the Treatment of Early Breast Carcinoma with Mastectomy Versus Breast Conservation Therapy

W e applaud the recent report by Poggi et al. 1 regarding the 18-year follow-up data of the National Cancer Institute randomized trial on breast conservation therapy (BCT) versus mastectomy (MT) for earlystage breast carcinoma. This trial, together with the 20-year follow-up trials conducted by Veronesi et al. 2 and Fisher et al., 3 has succeeded in demonstrating the long-term safety of BCT. All three randomized trials report that there is no difference in the long-term outcome between the BCT and MT groups in terms of overall and disease-free survival. These three studies also show no difference in the incidence of contralateral breast carcinoma and nonbreast malignancies between the two arms, although it may be argued that a 20-year follow-up period is not sufficient for detecting radiation-induced carcinogenesis and that the three studies were not powered to detect this difference between the two arms. Nonetheless, with these three landmark publications, we believe that the case against BCT should be laid to rest and that every woman should be offered the option of BCT.

Furthermore, we would like to raise our concern regarding the results of the study conducted by Poggi et al. 1 How is it possible that the 20-year disease-free survival rate (MT: 67%; BCT: 63%) of their cohort is higher than the 20-year overall survival rate (MT: 58%; BCT: 54%)? If their survival curves (see Figs. 1, 2 in the report by Poggi et al. 1 ) are plotted on the same graph, it is obvious that the disease-free survival curve crosses the overall survival curve just before the 15-year mark. This is theoretically impossible by definition. Is it possible that the authors confused the disease-free survival rate with the overall survival rate?