Mastectomy vs. Lumpectomy: Better Breast Cancer Treatment?

Should you ever find yourself wondering about whether mastectomy or lumpectomy is the better treatment option for breast cancer, you might want to check out a recent study by the Duke Cancer Institute which found that the less invasive lumpectomy (plus radiation) is better than mastectomy for early stage breast cancer.

Says lead author Dr. Shelley Hwang, “Our findings are observational but do suggest the possibility that women who were treated with less invasive surgery had improved survival compared to those treated with mastectomy for stage I or stage II breast cancer.” Dr. Hwang is the chief of breast surgery of the Duke Cancer Institute.

From a media release by dukehealth.org:

Taking advantage of 14 years of data from the California Cancer Registry, a source of long-term outcome data for women diagnosed with and treated for breast cancer in California, the research team found improved survival to be associated with the less invasive treatment in all age groups, as well as those with both hormone-sensitive and hormone-resistant cancers. Women age 50 and older at diagnosis with hormone-sensitive tumors saw the largest benefit of choosing lumpectomy plus radiation: they were 13 percent less likely to die from breast cancer, and 19 percent less likely to die from any cause compared with those undergoing mastectomy.

The team analyzed data from 112,154 women diagnosed with stage I or stage II breast cancer between 1990 and 2004, including 61,771 who received lumpectomy and radiation and 50,383 who had mastectomy without radiation.

The researchers looked at age and other demographic factors, along with tumor type and size to decipher whether each treatment had better outcomes for certain groups of women. Patients were followed on average for 9.2 years.

The researchers evaluated whether illnesses other than breast cancer, such as heart and respiratory disease, may have influenced whether women chose lumpectomy or mastectomy. Within three years of diagnosis, breast cancer patients who underwent lumpectomy and radiation had higher survival rates than those who chose mastectomy when all other illnesses were evaluated. This suggests that women choosing lumpectomy may have been generally healthier.

However, Hwang and her colleagues were surprised to also find that early stage breast cancer patients treated with breast-conserving treatment had a significantly better short-term survival rate from breast cancer than women who underwent mastectomy. A subset analysis limited to women with stage I cancer only showed consistent results.

What are health professionals saying about this finding? Here’s a sampling of the feedback we culled across the internets:

Sally Greenbrook, senior policy officer at UK charity Breakthrough Breast Cancer (via Daily Mail): “We welcome these significant findings, as we have known for some time that lumpectomy and radiotherapy is as effective as mastectomy for some women. These findings go further to suggest that lumpectomy with radiotherapy could be better than mastectomy in early stage invasive breast cancer.

We know, through speaking to women with breast cancer every day, how difficult it is to choose between a mastectomy and a lumpectomy.”

Dr. Wendy Woodward, section chief for breast radiation oncology at the University of Texas MD Anderson Cancer Center in Houston (via Health Day News): [She] said that for women with early cancers, the study “clearly reiterates there is no detriment to cancer control in having a lumpectomy and radiation for breast-conserving surgery candidates.” But, Woodward added, “I am not sure the study convinces us that lumpectomy and radiation is better for breast cancer survival, but it may be.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City (via today.com): “It’s good news in that a lot of women sometimes come in and feel that a mastectomy must be better than breast conservation.” But breast surgeons have had confidence based on previous studies that breast conservation surgery is equivalent to mastectomy for early stage cancer, Bernik said.

Professor John Boyages, professor of Breast Oncology and Director of the Macquarie University Cancer Institute (via MSN Health): “We have recently discovered that some women with a type of breast cancer called ‘triple-negative’ have a higher risk of cancer coming back in the chest wall and their glands after a mastectomy than women who have lumpectomy and radiation.

“Women who choose breast conservation, in many ways, get more treatment. They always should receive radiation, which reduces the risk of a ‘local’ recurrence in the breast and chest-wall, and has been shown to improve cure rates a little.

“Talk to a radiation oncologist, take time to read about choices and indications and contraindication for each technique. Once you have your breast off, it can’t be put back so it’s better to take it slowly and even proceed in small steps. A lumpectomy can proceed to a mastectomy if we find more cancer than we expected but sometimes women feel regret when they have a mastectomy and their tumour is much smaller than expected.”

Dr David Speakman, a breast surgeon from the Peter MacCallum Cancer Centre (via MSN Health): “The decision is always difficult — many women are understandably worried that if you don’t take off the whole breast you are leaving something behind.”

But if women are advised to have a mastectomy, Dr Speakman said they should take their doctor’s advice.

“It’s because it’s the best cancer operation for them,” he said. “If it’s too big or too close to the edge, then the safest thing is to have a mastectomy. And sometimes rural women will choose mastectomy because they don’t want to leave home for six weeks for radiotheraphy at a major centre.”