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Lumpectomy Versus Mastectomy

Lumpectomy Versus Mastectomy

Question

I have been given the choice of lumpectomy and radiation vs. Mastectomy. Can you please give some advice to help me make my decision? Is one treatment better than the other?

Answer

Gary Freedman, MD, Radiation Oncologist at Penn , responds:

Lumpectomy and radiation have been proven in large, well done clinical trials to result in equal cancer control and survival as mastectomy. However, the key is careful patient selection for breast conservation in order to achieve those good results.

First, a woman must be motivated to preserve her breasts. This means that she needs to have assessment of her future risk, be willing to undergo continued mammogram screening, etc. Some women have strong feeling of not wanting to preserve their breasts, some women feel the opposite and would not do a mastectomy. Many women are in the middle - if medically they are told they have equal survival, which is true in most cases, then they will choose breast conservation.

Second, medically the breast cancer must be eligible for breast conservation. Small early stage cancers up to about 5 cm, single rather than multiple parts of the breast involved, a negative resection margin by the surgeon, no history of prior radiation or condition that would preclude radiation ... these are all conditions that need to be met for lumpectomy and radiation.

In the United States, about 2/3 of women have lumpectomy and radiation and 1/3 have mastectomy.

This question and answer was part of the OncoLink Brown Bag Chat. Series, View the Life After Breast Cancer transcript.