Lumpectomy remains a viable option for women with early breast cancer despite revelations that a key study comparing it favorably to breast removal contained falsified data, doctors said yesterday.
But their assurances did little to assuage the anger felt by many women who made the agonizing choice to have breast-conserving surgery after weighing the study, which found no difference in survival rates.
"I have no doubts about the choice I made -- obviously I'm eight years surviving, and that speaks for itself," said Marsha Oakley, a nurse who runs the breast cancer screening program at St. Agnes Hospital.
"But I'm just angry that this sort of thing keeps happening, and it happens to American women."
Ms. Oakley, 46, who is president of a support network known as Arm-in-Arm, said her greatest fear is that the fraud has so undermined confidence in the medical establishment that some women will be scared away from considering lumpectomy or seeking any treatment.
Shocking doctors and patients, a Chicago Tribune article Sunday revealed that a Canadian researcher faked data he contributed to a large study that convinced many physicians that mastectomies were not always necessary to stop cancer from spreading.
The study, directed by the University of Pittsburgh, found that removing the cancerous lump while saving the surrounding breast tissue is just as effective.
The operation, known as lumpectomy, is followed by radiation treatments.
Many doctors and patients said yesterday that they were encouraged by the latest wrinkle in the unfolding controversy: an announcement Monday by the National Cancer Institute that the central conclusion about lumpectomy held up even without the false data.
The researcher responsible for the fraud, Dr. Roger Poisson of St. Luc's Hospital in Montreal, contributed about 16 percent of the data in the study.
He has been barred from receiving federal research funds, and no longer takes part in the multicenter project known as the National Surgical Adjuvant Breast and Bowel Project.
The project has produced many key findings about breast cancer. Although other studies have affirmed the value of lumpectomies, the project was the largest to find that survival rates for women with early breast cancer were the same whether the entire breast or just the malignant lump was removed.
The finding, reported in 1985, brought about a major shift in the choices presented to women whose breast cancer is detected before spreading to other parts of the body.
Dr. John Fetting, co-director of the breast cancer unit at Johns Hopkins Hospital, said yesterday that he was "disappointed" by the fraud but convinced that doctors and their patients should not change the way they regard the two treatments.
"There was misbehavior here, but it's not a threat to the scientific integrity of the findings," he said.
He said he was encouraged not only by the cancer institute's reappraisal, but also by the fact that the study was just one of five to reach the same conclusion about the relative merits of total and partial breast removal.
Others were done at the cancer institute and at several European institutions.
Also, in 1990, the cancer institute convened a "consensus development conference" in which a panel of breast cancer authorities reviewed available studies and heard verbal presentations by researchers and clinicians.
That panel also reached the same conclusion.
"The strongest proof of outcome in medical trials like this is whether or not someone else can do the same thing," said Dr. Joseph Aisner, an oncologist with the University of Maryland Medical Center. "This particular result has been proven and reproven."
The lumpectomy is favored by many women who want to preserve their appearance and avoid both the physical and emotional trauma of a mastectomy.
Still, many women choose mastectomy because it gives them greater peace of mind that the cancer has been removed.
"It's a wrenching decision," said Nancy-Bets Hay, a social worker at the University of Maryland Cancer Center.
"It's a choice between conserving as much of the breast as you can -- because that makes you feel you are still a woman -- vs. the feeling that the breast is something that you don't want in your body because it has cancer."
Ms. Hay, who had a mastectomy in 1988, counsels many patients wrestling with the difficult choice.
Dr. Trudy Bush, who does research into women's health issues at the Johns Hopkins School of Hygiene and Public Health, said she felt reassured by the new analysis but was "appalled" that the cancer institute waited three years to publicly disclose the fraud.
"The way it's been handled creates unnecessary distrust," she said. "As a result they've created suspicion about the overall validity of their results."