As of Tuesday, April 2, 2013
DEAR DOCTOR K: I was recently diagnosed with early-stage breast cancer. My doctor wants me to consider a lumpectomy plus radiation. But wouldn’t a mastectomy be more effective?
DEAR READER: In a lumpectomy, just the cancer and tissue immediately around it are removed, and radiation therapy is used to kill any nearby cancer cells that might not have been removed. In a mastectomy, the whole breast is removed. Since sometimes breast cancer cells (invisible to the eye of the surgeon) can spread into the surrounding breast, it’s plausible to think that a mastectomy might have a better cure rate than just a lumpectomy.
However, recent results from a large study add to evidence in support of a more conservative approach. That would be lumpectomy followed by radiation therapy.
The study included more than 112,000 women treated for early-stage breast cancer (cancer that has not spread beyond the breast or the underarm lymph nodes). Fifty-five percent of these women underwent lumpectomy and radiation, while 45 percent had mastectomy. Researchers followed the women for about nine years.
The study found that women who chose lumpectomy plus radiation were less likely to die of breast cancer or from any other cause than women who chose mastectomy.
Still, we should take these results with a small grain of salt. This was not a randomized trial, the gold standard of medical research. Women were not randomly assigned to one treatment or the other. Instead, each woman and her doctor decided on the treatment. It’s possible that women who chose mastectomy were less healthy to begin with, or at higher risk for aggressive cancer. Perhaps that’s why women who chose lumpectomy plus radiation did better.
Nevertheless, previously published major randomized trials suggest that women like you will do equally well with either lumpectomy and radiation or simple mastectomy.
Also, bear in mind that lumpectomy plus radiation therapy isn’t the best choice for all women with early-stage breast cancer. In general, mastectomy may be better for women with large tumors, or with more than one tumor in a breast. Mastectomy may also be better for women who were at higher risk for breast cancer, such as those who have close relatives with breast cancer or know they have a “breast cancer gene.”
If your doctor has said a lumpectomy is a reasonable choice, I’m assuming that the type of mastectomy being considered is a simple mastectomy: Just the breast would be removed, not tissues between your breast and armpit. Based on what you say, a larger operation would not usually be necessary.
For a woman newly diagnosed with breast cancer, it pays to carefully think through your options. Talk with your doctor and trusted friends and family to find the treatment strategy that’s best for you. The good news is that there is now solid scientific evidence that many women with breast cancer do not require mastectomy.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.