Sometimes plans change.  I have been following the recent news about a study from Duke University that a lumpectomy with radiation might actually be more effective than a mastectomy in preventing breast cancer recurrence.  The previous evidence suggested the two procedures were about the same, so women have been making their choice between these two procedures based mainly on personal preference for quite a few years now.

PJ Hamel has done a fine job of explaining the study and its possible limitations in her sharepost “First Don’t Panic, Do You Really Need a Mastectomy?” so I won’t review the details.  Instead I want to discuss the reasons it is important to head into that all important talk with your surgeon with an open mind.  The study snippets you see on television and the more in-depth articles you read at HealthCentral are about big groups of women.  You may or may not fit the profile of the people in the study.

Better imaging techniques, the use of markers at the time of biopsy, and improved precision of radiation all make lumpectomy a wonderful breast-conserving procedure that many women want to try.  But sometimes it doesn’t work out.  The size of the tumor in relation to the amount of breast tissue may make a lumpectomy impractical.  Sometimes the surgeon can’t get clean margins (a border of non-cancerous tissue around the tumor), and mastectomy becomes the best option.

One of the first things my surgeon said to me after my biopsy revealed that I had inflammatory breast cancer (IBC) was, “I’m sorry, but with this kind of cancer, breast-conserving surgery isn’t an option.”  It was one of those self-evident things that didn’t really need a statement from my point of view.  I didn’t know much about breast surgery, but I knew that to have a lumpectomy, you needed to have a lump.  My mammograms and ultrasounds didn’t show any lumps.  Instead, the cancer was diffused through the skin of my breast, so clearly the whole breast had to go.

Because IBC is already in the lymphatic system, it is treated with chemotherapy before surgery.  KIlling any cancer cells that may have wandered to the lungs or liver is more important than removing the breast first.  

I had plenty of time to read about mastectomies.  I read about the barbaric old days when the dreaded Halstead radical mastectomy butchered women.  Quite a few of the cancer activists I was reading weren’t happy with the number of surgeons who were still doing modified radical mastectomies instead of encouraging their patients to choose lumpectomy plus radiation, which by this time had been shown to be as effective as mastectomy.  I began to understand why my doctor started by stating that I was not a candidate for breast conservation surgery.  He probably had many women who were prejudiced against the mastectomy choice by the same articles I was reading.