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Lumpectomy, also known as breast-conserving surgery, is the surgical removal of a cancerous lump (or tumor) in the
breast, along with a small margin of the surrounding normal breast tissue. Lumpectomy may also be called
wide excision biopsy, breast conserving therapy or quadrantectomy (this latter term is
used when up to one fourth of the breast is removed). The procedure is often performed on
women with small or localized breast cancers and can be an attractive surgical treatment
option for breast cancer because it allows women to maintain most of their breast after
surgery. Several studies have shown that women with small breast tumors have an equal
chance of surviving breast cancer regardless of whether they have a lumpectomy, followed
by a full course of radiation therapy, or mastectomy (complete breast removal, which
generally does not require post-operative radiation
treatment).
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Who Is/Is Not a Candidate for Lumpectomy?
After a patient has been diagnosed with breast cancer, physicians will stage the cancer to determine the extent of the disease and help
decide the most appropriate course of treatment. Lumpectomy is often a suitable treatment
option for patients with the following breast cancers:
 Click here to learn more about these types of breast cancers.
Lumpectomy involves removing the cancerous breast lump and a surrounding margin of
normal breast tissue. In addition to the lumpectomy, a separate incision may be required
to include a sampling or removal of the axillary (underarm) lymph nodes. This part of the
surgery, which may be a sentinel node biopsy, an axillary
lymph node sampling, or an axillary lymph node dissection, is performed to determine
whether the cancer has begun to spread out of the breast itself (see the section below on
lymph node removal for more information).
After the lumpectomy is performed, the pathologist will check to make sure the surgeon
removed the entire cancerous tumor by seeing if the tissue margins are "clear"
(in other words, if there is no cancer present in the outermost edges of the breast tissue
sample). A preliminary check of the tissue margins may be performed while the patient is
still in the operating room and may allow the surgeon to obtain "clear margins"
during the same operation. However, this is only a preliminary reading, and the final
results, available over the course of a few days, may reveal residual cancer cells (known
as a "positive" margin). If the margins of the removed breast tissue do contain
cancer cells, then additional surgery (re-excision) is usually necessary to attempt to
remove the remaining cancer. If it is not possible to clear the margins on re-excision,
then a mastectomy is usually offered as an alternative.
Lumpectomy is often combined with adjuvant (additional) therapy, either local or
systemic. Most commonly, lumpectomy is followed by at least six weeks of radiation therapy to ensure that all cancer cells in the
remaining breast have been destroyed. Newer studies are beginning to show that shorter
radiation times may be equally effective in preventing local tumor recurrence for many
patients after lumpectomy; however, this is still under investigation. Other types of
adjuvant therapy that may be given in addition to lumpectomy include agents designed to
help control the systemic spread of breast cancer. These agents include chemotherapy, the drug tamoxifen (brand
name, Nolvadex), or a combination of hormonal or drug therapies.
Several studies have shown that lumpectomy is a viable treatment option for most women
with small, localized breast cancers. In fact, there is no statistically significant
difference in overall survival rates between women who undergo lumpectomy (and radiation)
and those who undergo mastectomy, although a slightly higher local recurrence rate was
reported in some larger studies in women who undergo lumpectomy instead of mastectomy.
More recently, a large study conducted by Yale researchers found that women with very
early-stage breast cancers who undergo lumpectomy followed by radiation therapy are no
more likely to develop a second cancer than women who undergo mastectomy, as long as
candidates are selected appropriately and the edges of the surgical sample are free of
cancer cells.
There are some women who are not good candidates for lumpectomy. The American Cancer
Society suggests that women who have already undergone radiation in the breast/chest area,
women with two or more areas of cancer in the same breast (known as multicentric disease),
women whose previous lumpectomy did not completely remove the cancer, women with
connective tissue diseases such as scleroderma (which make tissue sensitive to radiation),
or women who would be pregnant at the time of radiation therapy (possibly harming the
fetus) should not consider lumpectomy as advisable treatment. In addition, women with
cancers more than five centimeters in diameters (two inches) or women with larger cancers
within relatively small breasts may not be suitable candidates for lumpectomy. The
following chart summarizes conditions for which lumpectomy may not be the most suitable
choice:
|
Poor Candidates for Lumpectomy |
- Previously underwent radiation therapy in breast/chest
- Previous lumpectomy did not completely remove tumor
- Have two or more cancerous areas within the same breast
- Have connective tissue disease(s)
- Would be pregnant at the time of radiation after surgery
- Tumor larger than 5 centimeters (2 inches)
- Cancer large relative to small size of breast
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Source: American Cancer Society
Women who have been diagnosed with breast cancer should carefully discuss their
treatment options with their surgeon and other members of their cancer treatment team.
Lumpectomy is becoming an increasingly suitable option for many women with early stage
breast cancers. While some women are clearly not candidates for lumpectomy (and would
benefit more from mastectomy), studies have shown that the type of breast cancer surgery a
patient receives is sometimes influenced by her surgeon’s personal preference,
geographical location, age, or insurance coverage. It is very common and usually
recommended that patients seek a second opinion before undergoing any type of surgery.
Rates of Breast-Conserving Surgery by U.S. Region |
Northeast
North Central
West
South |
60.5%
51.1%
50.2%
48.0% |
CONTINUED
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