The study focused on the surgical and systemic treatment of lobular breast cancer, a specific form of cancer that develops in the mammary gland and is identified in 15% of breast cancer patients. The treatment for this type of cancer is similar to that of the more common ductal breast cancer.

Mastectomy
Following a comprehensive analysis of data on more than 150,000 patients in the Dutch Cancer Registry, Truin determined that mastectomies are far more common with lobular breast cancer than with ductal breast cancer. This is striking, given that the treatment protocols for both types of cancer are identical. The researchers believe the reason for this discrepancy is because the size of a lobular tumour is harder to determine on an X-ray. 'That makes breast-conserving surgery much more difficult and also makes it harder to remove all of the tumour tissue. To prevent a follow-up operation, many surgeons probably opt for a mastectomy,' says the PhD candidate.

Chemotherapy
Truin also studied the effects of administering chemotherapy before surgery for patients with lobular breast cancer. Chemotherapy is usually administered before surgery to shrink the tumour. As an added advantage, it makes breast-conserving surgery easier to perform. However, research has shown that women with lobular breast cancer do not respond as well to chemotherapy. 'This may be another reason why surgeons opt for a mastectomy,' says Truin.

Chemotherapy doesn't appear to improve life expectancy when administered after surgery either. Truin came to this conclusion after examining post-menopausal women who received both chemotherapy and hormone therapy. Positive effects were found in women with the more common ductal breast cancer.

Personalised
All in all, there were indeed differences in the treatment received by patients with lobular and ductal breast cancer, despite identical protocols being in place. According to Truin, additional research is needed before the guidelines can be adjusted. 'We want to develop a more specific treatment protocol to maximise the effectiveness of the therapy. But before we can do this, it's important to determine which treatments are effective.'

Wilfred Truin will obtain his PhD on 24 March from Maastricht University for his dissertation, titled 'Surgical and systemic treatment of lobular breast cancer'.

In addition to Truin, the research team consisted of surgeon Dr Rudi Roumen of Máxima Medical Centre, epidemiologist Dr Adri Voogd of the Netherlands Comprehensive Cancer Centre and medical oncologist Dr Vivianne Tjan-Heijnen of Maastricht University Medical Centre+. The team is calling for further research on this topic in order to develop more specific treatment protocols in the future for women with lobular breast cancer.