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A recent study, presented at the 2019 annual meeting of the American Association for Cancer Research, or AACR, in Atlanta, brought about another round in the controversy surrounding surgery for stage 4 breast cancer patients.

The study reveals that patients with stage 4 HER2-positive breast cancer that have been treated with systemic therapy (which could include chemotherapy, targeted therapy, or endocrine therapy), had a 44% increased chance of survival.

The authors of this study, Ross Mudgway and Dr. Sharon Lum conducted a retrospective cohort study of 3,231 women with HER2-positive stage 4 breast cancer, using records from the National Cancer Database from 2010-12.

Dr. Elizebeth Arena, a Breast surgeon with the Surgery Group of Los Angles, believes the study asks an important question about how to best treat women with Stage IV disease, but cautions her patients about the findings from this preliminary study.

“Traditionally women with Stage IV breast cancer are unlikely to undergo breast surgery since the cancer has already spread to other parts of the body. As we see remarkable advances in response to medical treatment, we need to identify which patients can benefit from every treatment option, including surgery. This is an exciting new time in breast cancer treatment, and questions like this will best be answered with clinical trials that are currently underway.”

The study also examined socio-economic factors about the stage 4 breast cancer patients who were offered surgery.  They discovered that women with Medicare or health insurance were more likely to have surgery and less likely to die of their disease than those without Medicaid or health insurance.

Dr. Joshua Ellenhorn, a Clinical Professor of Surgery at Cedars Sinai, agrees that disparities in health care due to race and socioeconomic factors must be addressed.  He explains that the decision about whether or not to recommend surgery to patients, involves numerous other factors.  “Resecting a tumor in a patients with Stage 4 Metastatic Breast cancer, makes sense if the patient can expect an increase in overall life expectancy.  It doesn’t make much sense if there is metastatic disease that will end the patients life.”

Furthermore, Dr Ellenhorn, believes that more research is needed to help doctors identify which patients will live longer if they are offered surgery.  Patients who have questions about breast cancer should feel comfortable about their treatment plan and their surgeon.  At the Surgery Group of Los Angles, our surgeons help patients understand the risks and benefits using surgery with curative intent when treating breast cancer.

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