Questions and answers on breast cancer
GUIDELINE 3. MASTECTOMY OR LUMPECTOMY?
CHOOSING THE MOST APPROPRIATE OPERATION
FOR WOMEN WITH EARLY INVASIVE BREAST CANCER |
What is mastectomy?
Mastectomy is the removal of the whole breast. Until the mid-1980s, this was the usual treatment for early breast cancer.
What is lumpectomy?
In a lumpectomy only the tumour is removed, along with a "shell" of healthy tissue to ensure that the whole tumour is taken. Because most of the breast remains in place, lumpectomy is often called "breast-conserving surgery" (BCS). You may also hear it called "partial mastectomy" or "segmental resection."
Do I have a choice between mastectomy and lumpectomy?
Yes, in most circumstances. There is clear evidence that lumpectomy, when followed by radiation therapy, is just as effective as mastectomy, which means that they are both effective in removing the tumour and reducing the chances of the cancer returning. Since they are equally safe, the deciding factors are often your own personal preference and circumstances, as long as the cancer is in the early stages. For most women, lumpectomy is now the recommended procedure.
What are the advantages of lumpectomy?
Mastectomy removes the whole breast. With a lumpectomy, most of your breast stays the way it is. After mastectomy you can have your breast reconstructed by plastic surgery, but you may lose the natural "feel" and shape of the breast.
Are there disadvantages to lumpectomy?
Yes. After the surgery, you need to have radiation treatment (radiotherapy) daily for several weeks to reduce the risk of the cancer returning in the same breast. Depending on where you live, it may be inconvenient or difficult for you to get to a treatment centre. Radiotherapy may also cause problems like swelling and pain in your breast.
Another problem may arise if the cancer was not completely removed during the lumpectomy. If the tissue that was removed is still found to have cancerous cells on its edges (when examined later under a microscope) you will need another operation. This will be either a second lumpectomy (taking more tissue this time) or a mastectomy. Sometimes only a few abnormal cells are found on the edge of the removed tissue. In this situation, radiotherapy may be able to destroy these cells without requiring additional surgery (see guideline 6).
If I have a lumpectomy followed by radiation treatment, can the cancer still come back?
Yes, it can. But the chance of this is low and no greater than after a mastectomy. In about 1 out of every 10 women, cancer will come back in the same breast or in the underlying chest wall within 10 to 15 years after surgery, no matter which operation is chosen. In some cases, chemotherapy or hormonal treatment can lower this rate still further. For more information on these additional treatments, see guidelines 7 and 8.
If cancer does come back in the treated breast, another operation, either lumpectomy or mastectomy, will be necessary.
If lumpectomy is safe and preserves the breast, what are the advantages of a mastectomy?
Mastectomy is preferable for some women. There are several possible reasons:
- Some kinds of cancer are more likely to come back in the same breast, even after radiation treatment. This may make a mastectomy preferable.
- If a woman is unable to have radiotherapy after lumpectomy, the chances are higher that the cancer will return. Factors that would make radiotherapy inadvisable include pregnancy, previous radiation treatment to the breast, a disability such as arthritis that prevents you from lying flat or stretching out your arm, and certain diseases, such as systemic lupus erythematosus or scleroderma.
- In some instances the tumour may be very large in proportion to the breast. In this situation, removal of the tumour may mean loss of so much tissue that the cosmetic result would be poor. Mastectomy would then be the better option.
Is it possible to have a lumpectomy even if I can't have radiation treatment afterward?
Lumpectomy is still possible. However, you would have a high risk (about 40% within 8 years) of the cancer returning in the same breast.
If the cancer does come back, you will need more surgery and perhaps treatment with anticancer drugs. Nevertheless, your chances of prolonging your life would be the same as if you had had a mastectomy in the first place.
What if the tumour is right next to or involving the nipple?
You can still have a lumpectomy, but the operation will require special skill and experience. It may be necessary to remove some or all of the nipple and surrounding tissue. Some sensation may be lost, but with plastic surgery the shape and appearance of the breast can be almost normal.
My doctor says I should have the lymph nodes ("glands") in my armpit removed too.
This is often recommended. For detailed information, please see guideline 4 in this series.
What are the most important things to consider in making my choice?
There is no evidence that either lumpectomy or mastectomy leads to a better overall quality of life. This means that your own preference, lifestyle and priorities are important factors in the decision. For example, you may live so far from a treatment centre that travelling to and from radiation sessions could be difficult and time-consuming. In this situation, you may prefer mastectomy over lumpectomy.
You should weigh all the information carefully. Above all, don't feel rushed into making a decision. Take your time. A delay of 1 or 2 weeks will have no significant effect on your situation. Maintaining a healthy, positive self-image over the long term is important, and you should keep this in mind when making your choice. You are the best judge of your feelings about your body and the effects that each operation may have, and it has been found that women who take an active part in these decisions are less likely to feel depressed afterward.
