Deciding over Breast Cancer Treatments: Lumpectomy or Mastectomy

PJ Hamel Health Guide March 09, 2008
  • I had a flashback to one of the worst parts of cancer treatment recently. No, not the prolonged pain of raising my arm over my head for radiation, when said arm was still protesting the role it had played in my very recent mastectomy and reconstruction. And not the guilt and anger at missing my high school son’s soccer playoff game because chemo had made me too weak to get out of bed and drive 2 hours that day. No, I was recalling having to make a treatment decision: lumpectomy, or mastectomy? Go for the lighter, easier surgery, and hope the margins are clean and no cells have escaped? And wonder… will it come back? Will I end up hating myself because I didn’t choose the more fail-safe treatment? Or have the mastectomy, and forever alter the geography of my body in a major way–plus face a possible range of arm and shoulder issues?

    I chose lumpectomy, figuring I could always have a mastectomy later if necessary. I had the lumpectomy; it didn’t do the trick, so I had the mastectomy anyway. But oh, how I agonized over that initial decision!

    A friend of a friend is going through a similar situation. After her diagnosis she had a lumpectomy, and no lymph nodes were involved. Having recovered from the lumpectomy, she recently went for an initial appointment with her oncologist, fully expecting to schedule radiation and go on her merry way. But hold on: the oncologist told her that if she did chemo, she’d reduce her risk of recurrence by 4%. And furthermore, he wanted her to join a clinical trial. “And oh, by the way–I need your answer on everything by tomorrow.”

    Needless to say, this woman was shocked, then angry, then fearful, and starting to feel a mega-dose of guilt. “What if I refuse chemo? What if it comes back?” On the other hand, with a husband and two teenage daughters, she felt very reluctant to “put them through the hell of my going through chemo,” when the up side was a mere 4% improvement in her risk of recurrence. When last I heard, via our mutual friend, she was preparing to spend a sleepless night. What should she do?

    First of all, that oncologist had no right to ask her for an answer in less than 24 hours. I’d suggest to her that she simply refuse until she’s good and ready. Heck, every decision we make as breast cancer patients feels fraught with danger. What if I make the wrong decision and my cancer comes back? What if I die and leave my children without a mother, my husband without a wife? It takes time to process those feelings, to separate emotion from fact, to talk with others who’ve been through something similar. An extra few days or week certainly won’t make the difference between life and death.

    Next, I’d have her talk to her family, rather than try to spare them. Families are generally more resilient than we give them credit for. Husbands or significant others step up to the plate; kids can be surprisingly kind and mature, especially teenagers. It’s tempting to martyr yourself on the altar of your family, but is that what they really want? Probably not. Give them credit for loving you as much as you love them.

  • Finally, I’d get a second opinion. It’s often exactly what you need, when you’re sitting on the fence and not tipping either way. Good doctors always welcome you advocating for yourself; they know that if you feel pushed into treatment, it’s less likely to be a successful experience.

    As it turned out, my friend-of-a-friend was offered a place in an Oncotype-DX trial, the preliminary gene test for which will let her know very specifically how likely she is to have a recurrence if she doesn’t do chemo. If recurrence is very unlikely, she’ll probably tip away from chemo. If very likely, she’ll tip towards it. If she’s right in the middle… well, she’ll be in that spot where we so often find ourselves, rolling the dice. But at least she’ll have had time to calm down, gather information, and feel good knowing she did everything possible to make a decision that’s right for HER.