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Two studies that followed breast cancer survivors for 20 years found that the type of
surgery they had—lumpectomy or mastectomy—did not effect their chances of surviving the
disease. Though preliminary data have suggested that chances of survival with the
breast-conserving surgical option (lumpectomy) were equal to removing the entire breast
(mastectomy some physicians still believed that taking out more breast tissue was better
and therefore did not present the lumpectomy procedure as a valid option to their
patients. According to the researchers, these new studies should assure women and
physicians that lumpectomy is a safe, viable option for most patients with small breast
cancers.
For over a decade, the National Institutes of Health has recommended that women with
early stage breast cancers be offered the option of either lumpectomy (followed by radiation) or mastectomy. Yet despite this
recommendation, studies have found that surgical options often depend on the
physician’s own preference, geographical region, and the medical center setting, with
community hospitals performing more mastectomies on small cancers than academic centers.
The two newly released studies should dismiss any lingering doubts about the lumpectomy
procedure.
The first study was conducted by Umberto Veronesi, MD from the European Institute of
Oncology and colleagues from Milan, Italy. The researchers followed 701 women with breast
cancers measuring less than two centimeters in diameter. All of the women had either
lumpectomy followed by radiation therapy or mastectomy. Additionally, some of the women
had lymph nodes removed and received chemotherapy.
In another study, begun in 1976, Bernard Fisher, MD and colleagues from the National
Surgical Adjuvant Breast and Bowel Project at the University of Pittsburgh, analyzed data
from women who underwent mastectomy, lumpectomy, or lumpectomy with radiation. The aim of
the study was to assess treatment options for women with invasive breast cancer.
Both of the studies found that women who underwent lumpectomy were just as likely to
survive breast cancer as the mastectomy patients. The researchers of the second study
concluded that radiation therapy following lumpectomy continues to be an "appropriate
treatment option" for women with breast cancer so long as a margin of normal breast
tissue is removed around the breast cancer tumor and that the cosmetic results of the
surgery are acceptable.
"The long-term survival rate among women who undergo breast-conserving surgery is
the same as that among women who undergo radical mastectomy. Breast-conserving surgery is
therefore the treatment of choice for women with relatively small breast cancers,"
conclude Dr. Veronesi and his colleagues from the Italian study.
Women with breast cancer should weigh the advantages and disadvantages of both
lumpectomy and mastectomy with their cancer treatment team to determine which treatment is
best for them. Lumpectomy may preserve the physical appearance of the breast but usually
requires six to seven weeks of radiation therapy. Mastectomy may reduce the chances of a
local recurrence of breast cancer but additional decisions about breast reconstruction are introduced. Also, some women
may be better candidates for mastectomy than lumpectomy or visa versa depending on their
individual medical situation.
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