Mastectomy may have less benefit than lumpectomy
According to a new study among early stage breast cancer survivors, those who receive a lumpectomy plus radiation and those who have a mastectomy both have similar rates of survival. The latest research indicates the more invasive surgery isn’t necessarily the better option. NBC’s Dr. Nancy Snyderman reports.
Under certain circumstances, people with breast cancer have the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Deciding factors
Although most women who have a choice prefer the less invasive lumpectomy, deciding between lumpectomy and mastectomy depends on a how you feel about the following:
Do you want to keep your breast? If it’s important to you to keep your breast, you may decide to have lumpectomy with radiation instead of mastectomy.
Do you want your breasts to match as much as possible in size? For most women, lumpectomy has a good cosmetic result. In rare cases when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted. There are reconstruction options available for both lumpectomy (if there is significant distortion) and mastectomy. If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
How anxious will you be about breast cancer coming back? If removing the entire breast would help you worry less about the possibility of the breast cancer coming back (recurrence), you might consider mastectomy.
There are also other, less personal factors that can affect which type of surgery you have:
Where you live: Research has shown that women who live in the United States are more likely to have mastectomies than women in other countries. In the Midwestern and southern parts of the U.S., mastectomies are very common. We don’t know why this is, but it probably has something to do with the attitudes of women and their doctors.
Where you go for treatment: Lumpectomies are more commonly performed in university-based hospitals than in community hospitals.
When the surgeon was trained: Older surgeons in some parts of the United States may be more old-fashioned and less likely to offer lumpectomy with radiation as an option for their patients, particularly their older patients. Until the mid-1980s, mastectomy was the standard of care for any stage of breast cancer, and research has shown that surgeons trained before 1981 recommend mastectomy more often than lumpectomy. If you feel strongly about one option over the other, ask your surgeon how many mastectomies and lumpectomies he or she performs and why. Seek a second opinion to get a more complete and balanced understanding of your options. Don’t let hidden biases or unchanging attitudes keep you from getting the best care.
What Is a Preventive Mastectomy?
Women who have a high genetic or familial risk of breast cancer may elect to have a preventive mastectomy. Preventive mastectomy is also called prophylactic mastectomy. It may be a total mastectomy with the removal of the entire breast and nipple. Or it may be a subcutaneous mastectomy, where the breast is removed but the nipple is left intact.
Studies show that the occurrence of breast cancer may be reduced by 90% after preventive mastectomy in women with high risk for this disease. Sometimes, women who have had breast cancer in one breast will decide to have a preventive mastectomy to remove the other breast. This can reduce the chance of cancer recurrence. In some cases, both breasts are removed. This is called a double mastectomy.
Breast reconstruction can be done at the time of the preventive mastectomy (immediate reconstruction) or it can be scheduled for a later time (delayed reconstruction). During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of the body to create a breast.
What Is a Partial Mastectomy?
Doctors may perform a partial mastectomy for women with stage I or stage II breast cancer. The partial mastectomy is a form of breast-conserving therapy in which the part of the breast containing the tumor is removed. This procedure is then followed by radiation therapy to the remaining breast tissue. With radiation therapy, powerful X-rays target the breast tissue. The radiation kills cancer cells and prevents them from spreading, or recurring in the area of the breast.
A lumpectomy (wide local excision) removes just the tumor and a small cancer-free area of tissue surrounding the tumor. If cancer cells are found later, the surgeon may remove more of the tissue. This procedure is called re-excision.
Another type of partial mastectomy is called a quadrantectomy. For this procedure, the surgeon removes the tumor and more of the breast tissue than is removed with a lumpectomy.
In some cases, more surgery is required after a partial mastectomy. Sometimes, if cancer cells are still in breast tissue, it may be necessary to remove the entire breast.
What Is a Radical Mastectomy?
A radical mastectomy is the complete removal of the breast, including the nipple. The surgeon also removes the overlying skin, the muscles beneath the breast, and the lymph nodes. Because radical mastectomy isn’t more effective than other less extreme forms of mastectomy, it’s rarely performed today.
A less traumatic and more widely used procedure is the modified radical mastectomy (MRM). With the modified radical mastectomy, the entire breast is removed as well as the underarm lymph node. But pectoral muscles are left intact. The skin covering the chest wall may or may not be left intact. The procedure may be followed with breast reconstruction.