In women who are eligible for breast conserving treatment, I am often asked the question,
gee Dr. Harness would I be better off if I had a mastectomy.
Now there is an important recent paper out on this very subject, it comes in March of
2012 and it comes from the journal cancer and I have it right here and it is called
survival after lumpectomy and mastectomy for early stage invasive breast cancer.
Now remember early stage invasive breast cancer, stage I and stage II.
This is an important study from a dear friend of mine, Dr. Shelley Wong who is now at Duke
University.
The registry data that was looked at here was the California Cancer Registry.
They looked at data from 1990 through 2004 for 15 years and the question was, is lumpectomy
or mastectomy, are they the same, one better or worse than the other?
Now, we have known for many years that there has been equivalency between mastectomy and
lumpectomy as far as overall survival goes.
As I tell women all the time, if we save the breast then there is a chance the cancer can
come back in the breast but that hopefully then does not impact overall survival.
So, we have known for 25 years or longer actually that there is no difference in long term survival.
So what made this particular study somewhat unique.
Well, it had an interesting finding and the finding was that women who are older than
age 50, who had estrogen receptor positive breast cancers actually did better than women
who had mastectomies and the reasons for this are not really clear but the facts, you know,
stand for themselves.
So how then does an important study like this influence you and the answer is it is important
piece of information and you can take it in but there are no guarantees associated with
this for your individual case.
Please remember that breast cancer is a galaxy of diseases going from very very benign acting
all the way over to super-aggressive acting.
Often in a study like this, women who had little bit larger tumors or a few more nodes
positive, perhaps got to mastectomies but the reality was that the women who were 50
or older and had estrogen receptor positive cancers, actually had a little bit better
overall survival.
Now study like this should not be the final factor in influencing your decision about
lumpectomy versus mastectomy.
Remember, there are advantages to age, there is no perfect solution one over the other.
With lumpectomy, you need radiation therapy.
There are some exceptions to this in women who are 70 and older but in general, they
always need radiation therapy and because the breast is there, you have got a small
chance each year that the cancer can come back.
With mastectomy, you lose your breast, you lose sensation, but indeed we have better
ways of performing reconstruction now including nipple sparing mastectomies.
Now when you are considering lumpectomy, please remember that there are different options
when it comes to the radiation therapy that you need and hopefully your near a location
that even offers intraoperative radiation therapy, that in the US at least is done under
a protocol as a single one time treatment in highly selective cases or the intraoperative
radiation therapy can be used as a boost followed by either three or five weeks of radiation
therapy.
The bottom line is always, please be working with a multidisciplinary team.
The nice thing about Dr. Wong's study is there is certainly no inferiority across all age
groups when it comes to choosing a lumpectomy, but the key to this is to be with a multidisciplinary
team the key is the appropriate and proper radiation therapy plus the other adjunctive
therapies.
Hopefully, you find this information helpful to you in your decision making process.
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