text_1: Women with Stage 4 breast cancer survive longer if they have surgery, study shows
text_2: This story is about a large retrospective study that was published this week in the journal JAMA Surgery. The research suggests women who opted for surgery to treat their breast cancer had better survival rates than those who didn’t, even though the number of surgeries has plunged from 1988 to 2011. This Washington Post report does many things well: It quantifies the benefits of breast surgery in absolute terms, points out the study’s limitations and doesn’t make sweeping recommendations based on this research. Furthermore, the story uses cautionary language, making readers really question whether surgery is the better option for stage 4 breast cancer patients. It also incorporates two independent sources who provide some critical perspectives, such as the two other small studies that showed no correlation between surgery and survival in this group of women. We would have liked to have seen more discussion on the harms of breast surgeries, as well as the existing therapies for breast cancer patients. And we would have liked for the report to have pointed out that usually younger women underwent surgery in the study, which may have affected the results. Overall, however, the Washington Post puts forth a thorough, nuanced story based on the latest findings. Though current screening recommendations for breast cancer are intended to identify cancers at an earlier, more curable stage of disease, women still present with metastatic disease (cancer that has spread to other parts of the body). This can occur because of not having screening or not having it regularly enough, or it may relate to aggressive disease that develops and metastasizes prior to it being detected on standard imaging tests. For those women with metastatic disease, particularly younger ones, cure and thus long-term survival is uncommon. The question addressed in this story is whether the addition of surgery to standard aggressive therapy – generally chemotherapy and radiation treatment – leads to longer survival. The story does a good job of describing the benefit seen in this retrospective study as well as highlighting its limitations. Specifically, there is no evidence from higher quality, prospective studies that surgery provides additional survival benefit. Clearly such studies are needed and the article suggests that such studies are currently underway. The challenge is what to recommend for women who currently face this treatment decision. The simple answer is that we don’t really know and the article does a good job of not overselling surgery based upon the results of this study.