Related topics: •  Breast Cancer Center •  Breast Cancer Surgery •  Breast Cancer Treatment Overview

For years, many breast surgeons have argued that a lumpectomy (removal of the cancerous tumor plus some surrounding tissue) is as lifesaving for women with early-stage breast cancer as a mastectomy (removal of the whole breast). These voices have risen to a chorus as numerous long-term studies show no lower survival rate after a lumpectomy as long as the tumor is within certain boundaries.

In 1992, when the National Cancer Institute made its recommendations in favor of lumpectomies for early-stage breast cancer, it based that conclusion on five clinical trials involving 1,447 women who had lumpectomies followed by radiation therapy, versus 1,407 women who had mastectomies. Both procedures were equally effective. In 2008, a 20-year study published by the Danish Breast Cancer Cooperative Group also found that lumpectomies were as effective as mastectomies.

The news on lumpectomies is encouraging for any woman diagnosed with early stage breast cancer. Of course, the appropriate surgery and follow-up treatment for you is best worked out with your doctor. In nearly all cases, you will need surgery. The question is how extensive it will be.

A lumpectomy, also known as breast conservation surgery, involves removing the tumor, about three-fourths of an inch of surrounding normal tissue, and possibly some lymph nodes in or near the armpit. If the cancer is caught by stage I or II, meaning that it's less than 5 centimeters (2 inches) in diameter and hasn't spread beyond the underarm lymph nodes to any other part of your body, you are most likely a good candidate for lumpectomy.

The surgery is done as an outpatient procedure, or with an overnight stay in the hospital, and most patients need six to seven weeks of radiation treatment afterward to destroy any cancer cells that may remain after surgery. A newer technique involves giving a higher dose of radiation every day for only five days. (Most mastectomy patients do not need radiation unless they had very large tumors or more advanced disease.)

Whether you also receive chemotherapy or any other drug therapy is independent of the type of surgery you have. It depends on other factors, like the type and grade of the tumor, lymph node involvement, and size of the tumor, as well as other considerations, including your age and overall health.

Tumor size is not the only determining factor to having a lumpectomy. A woman's breast size relative to the size of the tumor could tip the scale one way or the other. It would be more acceptable, for example, for a large-breasted woman with a large tumor to have a lumpectomy, but for a small-breasted woman with a large tumor, a lumpectomy may not be an option.

A sort of middle ground between a lumpectomy and a simple mastectomy is known as segmental mastectomy, sometimes called quadrantectomy. Generally, this is used to remove larger tumors. A quadrantectomy involves removing about one-fourth of the breast, including the lump, more surrounding tissue than a lumpectomy, and some nearby lymph nodes. This is also followed by about six weeks of radiation. Keep in mind that having part of your breast removed can be less traumatic than losing all of it, but it may be more disfiguring and a partial breast is harder to reconstruct than a breast that's entirely gone.

You may need general anesthesia, especially if you're getting lymph nodes removed. If there's no lymph node involvement, some doctors give lumpectomy patients local anesthesia with IV sedation. You'll have a dressing on the incision and will likely have a drainage tube in your armpit that will be removed either before you go home or at a later office visit. Women generally have little pain after the day of surgery, but many report numbness near the removed lymph nodes that may gradually dissipate over time.

Lumpectomy is not a good option if you're pregnant because the follow-up radiation treatments could harm the fetus. If you've had radiation to the chest for another reason, you should not be exposed to more. Having had Hodgkin's lymphoma or a prior breast cancer on the same side treated by lumpectomy with radiation would tend to rule out a lumpectomy for you. Also, if you have lupus or scleroderma, radiation could cause scarring or damage to your connective tissue. Diminished lung capacity would be another reason to decide against radiation therapy. It's also likely you won't be able to get a lumpectomy if you have two or more tumors that are too far apart to be removed with one incision, or if you have one tumor that's very large.

This is a decision that you need to make with your doctor, and it depends greatly on the stage of the cancer and its location. Beyond that, it will also depend on your comfort level. Some women opt for mastectomy so they can be more certain they've gotten all the cancer that could possibly be in that breast (although even a mastectomy cannot remove 100 percent of the breast tissue). Others choose to get a mastectomy because they don't want to have radiation treatment. But some women are resolved to preserve as much of their breast as possible, and six weeks of radiation therapy seems a small price to pay.

If you have early-stage breast cancer, whatever surgery you receive, there appears to be no difference between lumpectomy and mastectomy on your long-term outlook. Dr. Julia Rowland of the National Institutes of Health surveyed nearly 2,000 breast cancer survivors one to five years after diagnosis: 57 percent received lumpectomies, 26 percent mastectomy alone, and 17 percent mastectomy with reconstruction. Rowland's survey asked these survivors to discuss their quality of life, body image, and physical and sexual well-being.

All were similar in terms of their emotional and social well-being, with two exceptions: women who had had mastectomies with reconstruction reported more problems with their sex lives, and those who had undergone lumpectomies had somewhat better body images than women in the other groups.

-- Elaine Herscher is a senior editor at Consumer Health Interactive.

References

University of Pennsylvania.

Last updated July 28, 2009
Copyright © 2001 Consumer Health Interactive

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