Notable breast surgeon and researcher, Dr. Kefah Mokbel, is advocating the benefits of breast-conserving therapy over mastectomy in certain patients, based on a combination of clinical evidence and the proposed biological mechanism of tumor cell homing.
This study delves into the comparison between breast-conserving surgery (BCS) followed by radiation therapy and mastectomy for breast cancer treatment, focusing on overall survival rates and the underlying biological mechanisms.
Mokbel notes that despite advancements in treatments, a significant number of patients still face relapses after initial treatment. Historically, studies from the 1970s suggested similar survival rates for patients undergoing BCS with radiation and those opting for mastectomy.
However, recent findings indicate that BCS followed by radiation might offer better overall survival benefits, thanks to advancements in systemic and radiation therapy.
One key aspect of this discussion is the introduction of a novel hypothesis centered around the “homing phenomenon.” This concept suggests that circulating tumor cells (CTCs) have the ability to return to the breast from which they originated, a process driven by chemotaxis, particularly involving the CXCR4-SDF-1 axis.
This biological mechanism could explain why BCS might lead to better survival outcomes compared to mastectomy, despite a higher risk of local recurrence with BCS. Essentially, the theory posits that the breast environment, particularly after BCS, might be more conducive to attracting and reactivating dormant tumor cells, thus potentially reducing the risk of distant metastases and improving overall survival.
Mokbel also explores the implications of this hypothesis for different types of breast cancer, including triple-negative breast cancer (TNBC) and ductal carcinoma in situ (DCIS), highlighting how BCS plus radiation therapy not only improves survival rates but also potentially reduces the likelihood of local and distant recurrences.
Mokbel suggests that radiation therapy may offer systemic benefits beyond merely reducing local recurrence risk, possibly through the activation of immune responses against tumor cells.
The study presents compelling evidence that breast-conserving therapy (BCT), when combined with radiation, offers superior overall survival benefits over mastectomy for treating early-stage breast cancer.
This advantage is attributed to a biological homing mechanism where circulating tumor cells preferentially return to their original breast environment, potentially reducing distant metastases and enhancing survival.
This insight underscores the significance of choosing BCT as a preferential treatment strategy in suitable patients, highlighting the need for further research to fully understand and exploit the homing phenomenon for improved cancer outcomes.
