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.