Locally recurrent breast Ca called 'life-or-death problem'.(Gynecology)

SAN ANTONIO -- The improved local control of breast cancer achieved via radiotherapy translates into a significant reduction in mortality due to the malignancy that becomes apparent only late, at 10 and 15 years' follow-up, Sir Richard Peto, Ph.D., reported at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

That's the good news regarding radiotherapy from a new metaanalysis of the world's total randomized clinical trial experience in early breast cancer. The bad news: This reduction in breast cancer mortality is essentially canceled out--and in some subgroups outweighed--by a radiotherapy-induced excess in late deaths due to cardiovascular disease.

"The big thing about radiotherapy is it causes deaths from heart disease, not in the first decade after treatment, but in the second," said Dr. Peto, professor of medical statistics and epidemiology at the University of Oxford (England).

Still, the central point remains: Local control of breast cancer matters. And if preliminary evidence turns out to be correct in suggesting modern radiotherapy techniques achieve it with much less cardiotoxicity than the radiotherapy of the 1980s, then physicians can expect to see a continued further decline in overall mortality in breast cancer patients in the decade beginning in 2010, he said.

"Local recurrence is not a cosmetic problem, it's a life-or-death problem," he said. "Breast cancer is a disease where you've really got to think of what you're achieving on a time scale of decades, not years. The question is not 5-year survival, the question for a middle-aged woman is what is the 20-year survival?"

Dr. Peto presented a metaanalysis of data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) involving 24,000 women randomized to radiotherapy or no radiotherapy in 46 clinical trials that enrolled patients in the ...