Lumpectomy vs. Mastectomy: Surprising New Findings

PJ Hamel Health Guide
  • “I want to be around to see my kids grow up. I want the most aggressive treatment possible. Never mind the lumpectomy – take it all off.”

    As moderator on this site for the past 5 years, I’ve read words like these, from women making surgery decisions, over and over again.

    When you hear the words “breast cancer,” your first thought is a fearful “I don’t want to die.” Your next is a defiant “Get the cancer out of my body – all of it, as fast as possible. I want the most aggressive treatment; it’s worth it.”

    Well, maybe not.

    The annual San Antonio Breast Cancer Symposium (SABCS), held last month, is the premier scientific symposium in the world for breast oncologists, breast cancer researchers, and associated healthcare professionals. And one of the presentations at this year’s session was surprising, to say the least:

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    Women with early breast cancer (no metastasis) who have breast conservation surgery (lumpectomy) followed by radiation are less likely to die of breast cancer within 10 years than women who have a mastectomy.

    WOW.

    How can that be? Wouldn’t removing your entire breast make it less likely for cancer to come back?

    In fact, it does – for some of us. Previous studies have shown that pre-menopausal women with hormone-negative cancer have less risk of recurrence with a mastectomy than a lumpectomy.

    And, in response to that and similar studies, women in general – pre- and post-menopausal, hormone-receptive or not – have come to believe that a mastectomy yields “safer” results.

    But reduced risk of recurrence isn’t the same as survival.  

    Women who had a mastectomy were more likely to die from breast cancer within 10 years, according to the results of this latest study.

    So you’re probably saying, “Well, yeah, if you have a mastectomy it usually means your cancer is more aggressive, and the tumor is larger, and it’s more likely to have spread to your lymph nodes. No wonder you’re more likely to die.”

    But all of those factors were taken into account. And the research still showed that women who had breast conservation surgery and radiation – pre- or post-menopausal, hormone-receptive or not, and regardless of race – were less likely to die within the first 5 to 9 years after surgery (the length of the study) than women who had a mastectomy.

    Now, before all of you who’ve had a mastectomy start to panic, chances are still VERY high that you’ll be alive within five years of treatment – the famous 5-year survival rate statistics we all hear about.

    For women in the study who had a lumpectomy, the overall survival rate was 93%. For women who had mastectomy, it was 87%. Good odds either way.

    And researchers are careful to cite one major fault in the study: no access to underlying health problems in the women involved, problems that could have exacerbated their overall health and wellness.

    Also, this is just one study; and it hasn’t yet undergone the lengthy review process that precedes publication in a medical journal. In other words, these are preliminary findings.


  • But according to Julia White, a professor of radiology at the Medical College of Wisconsin in Milwaukee, quoted in a post on WebMD, “We can be confident that breast-conserving therapy is at least equivalent to mastectomy,” as far as preventing death from breast cancer.

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    So, terrified though you might be at your new breast cancer diagnosis, don’t over-react.

    The size and/or location of your tumor; or the number of tumors in your breast might make a mastectomy mandatory.

    But if you have a choice between lumpectomy/radiation and mastectomy, think hard. The most aggressive surgery apparently isn’t a guarantee of better results.

     

    In the case of lumpectomy vs. mastectomy, less might very well be more.

Published On: January 11, 2011