A new study published Jan. 28 in Cancer, the peer-reviewed journal of the American Cancer Society, indicates that women opting for breast-conservation surgery (lumpectomy) and radiation may in fact have a better chance of surviving breast cancer than women who choose to have a mastectomy. Does this seem counterintuitive? Read on.
That’s the first emotion most of us feel when hearing the words, “You have cancer.”
We imagine cancer cells proliferating madly, eating away healthy tissue, spreading throughout our bodies, and finally killing us.
In reality, it doesn’t work like that. Most types of breast cancer grow very slowly; the lump you felt in your breast last week probably began as a small cellular aberration up to 8 years ago. So today’s cancer diagnosis is actually old news; and as such, shouldn’t force you into a hurried decision about treatment.
Which, unfortunately, is exactly what most women make: an emotional decision, based not on data but on fear. Many women feel that removing one (or both) breasts entirely gives them a better chance of surviving than simply removing the tumor, and delivering radiation to the removal site.
Yes, it’s true that having a mastectomy reduces your chance of a recurrence of cancer in the same breast – by about 90%. And having a completely healthy breast removed, which some women choose to do when confronted with cancer in just one breast, reduces the risk of cancer in that healthy breast by the same 90%.
But mastectomy doesn’t remove all of your breast tissue; and thus it doesn’t completely eliminate your risk of breast cancer.
According to a growing number of studies stretching back 5 years or more, mastectomy also doesn’t lessen your risk of dying, compared to the much less aggressive lumpectomy/radiation regimen. And the latest study, cited above, is the first to actually suggest that women opting for lumpectomy/radiation enjoy BETTER overall survival rates than women choosing mastectomy – single, or double.
Admittedly, there are issues with this newest study, carried out by researchers at the Duke Cancer Institute in Durham, NC. Cancer scientists cite “unmeasured variables” that could have contributed to the results.
For instance, in the Duke study, carried out over 30 years, many more women in the early years of the study had a mastectomy; and back then, chemotherapy simply wasn’t as effective as it was later on. Perhaps it’s lower-quality chemo, rather than mastectomy, contributing to a higher death rate.
In addition, women sometimes choose mastectomy simply because they’re unable to access radiation. Perhaps radiation interferes with their work schedule; or they can’t afford the daily drive to treatment. Some point out that this might correlate with lower quality of health care overall, due either to distance from treatment, or socioeconomic factors.
Still, the vast majority of doctors believe that lumpectomy paired with radiation gives women at least as much chance of surviving cancer as mastectomy. Dr. Kandace McGuire, a surgical oncologist at the University of Pittsburgh Medical Center, notes of the Duke study, “This study will be a very useful adjunct to a large body of evidence that shows at least equivalence of the two local therapies [lumpectomy/radiation and mastectomy]." (Mulcahy, 2013)
Still, why not do everything possible to avoid a cancer recurrence, even if you’re not increasing your chance of survival?
Quality of life. A mastectomy is aggressive surgery. Removing a breast affects balance, body image, and sex life; it can also lead to shoulder problems. Reconstruction can restore body image and balance, but is also a complicated surgery with many possible side effects – some permanent.
Bottom line: If you’ve just received a breast cancer diagnosis, DON’T PANIC. You have time to make a reasoned decision.
Speak with your surgeon about both types of surgery; make sure you thoroughly understand what’s involved. Talk to your oncologist about long-term outcomes: recurrence, survival, and lifestyle. Ask social services at the hospital for names of women who’ve been faced with a similar choice; see if you can connect with some of them to find out, in hindsight, what they think of their decision.
At the end of the day, you might very well decide that emotionally, you’d prefer to have a mastectomy. It’s your body; your decision. But at least that decision won’t be hasty; and it won’t be uninformed.
Kotz, D. (2013, January 29). Breast-sparing surgery may offer small survival advantage, but women still opt for mastectomies. Retrieved from http://bostonglobe.com/lifestyle/health-wellness/2013/01/29/breast-sparing-surgery-may-offer-small-survival-advantage-but-women-still-opt-for-mastectomies/2CTfU4CWmSN6D09vWV4lDO/story.html
Mulcahy, N. (2013, January 28). Lumpectomy may have better survival than mastectomy. Retrieved from http://www.medscape.com/viewarticle/778276