Lumpectomy or mastectomy? How did you decide?

PRB1956

Hi everyone.  My biopsy came back as Grade 2 for a 6 mm tumor.  ER+/PR+/Her2- .

How did you decide between a lumpectomy or a masectomy?   Did you get the lumpectomy and then based on lymph node/staging decide to go further with the masectomy?

I think I am changing where I will get treatment since I asked to see an oncologist and was told they (surgeon,onc, rad) will be meeting next week and I can talk to my surgeon after that.   I guess they don't understand that I want to talk to the people who will be treating me! 

keepthefaith

PRB,

I am glad you asked that question! I am in the same boat. I was DX'd on the 17th. Met with RO and MO. They are saying lumpectomy would be fine for me, but to concur with breast surgeon. I will be meeting with her on Thursday. RO says rads after chemo. I have a high grade tumor, with the same receptors as yours and larger tumor.  I want to know how the future screenings are done with both procedures and if those (more frequent) screenings raise the potential for re-occurence. I am sure rads do! With MX or BMX, I may not need rads. How much does MX or BMX vs LX, decrease my odds of re-occurence, if at all. I have read that LX w/Rads and BMX give you the same overall outcome. I wonder if they take the future screenings, chemo and rads into consideraton for that equation at all? I hope you get the answers you need. I am sure someone with more knowledge will post a reply.

Good luck with your appt next week!

SwoosieQue

I was diagnosed back in June, 2013.  The cancer (in my right breast) was "small", I was afraid that the doctors would NOT agree with my decision to have a bilateral mastectomy.  Yes, I wanted them BOTH removed due to the extremely high rate of breast cancer in my family, maternal and paternal sides, including my own mother. 

Believe it or not, my surgeon really didn't want to do the bilateral, she thought I was over-reacting... until after my surgery - she did the bilateral, it was approved through my insurance company after I submitted names and information of all family members with breast cancer -  test showed that the tissue in my left breast was pre-cancerous.

For me, I made the right decision.  Every woman needs to make her own decision as to course of treatment, our decision is personal, there is no 'right' or 'wrong' and whatever you do, do not feel defensive about your choice of treatment.  Right now, you need advocates, not criticizers, and you're in good company here.  

Good luck to both of you!

ruthbru

Everyone has a different take on things, but my advice would be to have the lumpectomy. Later if you find you need to, or are uncomfortable with a choice, a mastectomy is still possible, but if you start with it, there is no going back. Once your breast are gone, they're gone. Some things to think about:

* Having a mastectomy or lumpectomy have the same recurrence risk.

* having a mastectomy is NOT a guarantee that you will not need radiation

* a mastectomy is a more major surgery; with more possible complications, longer recovery time, more expense, time lost from work etc. etc.

* a mastecomy either means you will need to learn to live breast-free, which is a difficult adjustment for many, or you will have to undergo more hassle, expense, pain, recovery time, possible side effects etc. etc. doing of reconstruction....which does not guarantee good or lasting results....blah!

* when I was making my decision, I asked a friend who is a 35 year BC surivor and a surgical nurse. When she was diagnosed, you didn't have a choice...you had a mastectomy. Later, when it was widely available, she had reconstruction. So, she has seen BC from both sides of the operating table. When I asked for her opinion, she said (without skipping a beat), "If you have the choice of a lumpectomy, TAKE IT."

You are in the worst part now. Once you get a treatment plan in place, then you just do it...and come out on the other side. Best of luck!

sandcastle

The Choice is VERY PERSONAL.....I myself really wanted a Lumpectomy.....most would...but the Doctor explained to me and my husband that I would end up with a masectomy down the road.....believe ME I was crying so much.......so I did go with the Mascetomy...that was in December of 2010.....I had a Grade 2 Stage 0 with her- er/pr+ and I did NOT do Rads or Chemo  or Tamoxafin......after close to three years I am very happy I did this....it was my original site......the only thing I did have to do was have a hysteretomy for they knew it would travel.......so that is my take on this journey....Liz

ruthbru

I am going to copy this post from Beesie, in case she doesn't see this thread. She is the unbiased expert, and has great points to think of and consider:

Jun 20, 2013 12:00pm Beesie wrote:

Some time ago I put together a list of considerations for someone who was making the surgical choice between a lumpectomy, mastectomy and bilateral mastectomy.  I've posted this many times now and have continued to refine it and add to it, thanks to great input from many others.  Some women have gone through the list and decided to have a lumpectomy, others have chosen a single mastectomy and others have opted for a bilateral mastectomy. So the purpose is simply to help women figure out what's right for them - both in the short term but more importantly, over the long term.  

Before getting to that list, here is some research that compares long-term recurrence and survival results. What the research has consistently shown is that long-term survival is the same regardless of the type of surgery one has. This is largely because it's not the breast cancer in the breast that affects survival, but it's the breast cancer that's left the breast that is the concern. The risk is that some BC might have moved beyond the breast prior to surgery. So the type of surgery one has, whether it's a lumpectomy or a MX or a BMX, doesn't affect survival rates.  Here are a few studies that compare the different surgical approaches:

No Survival Benefit For Mastectomy Over Lumpectomy

Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer

Now, on to my list of the considerations:

• Do you want to avoid radiation? If your cancer isn't near the chest wall and if your nodes are clear, then it may be possible to avoid radiation if you have a mastectomy. This is a big selling point for many women who choose to have mastectomies. However you should be aware that there is no guarantee that radiation may not be necessary even if you have a mastectomy, if some cancer cells are found near the chest wall, or if the area of invasive cancer is very large and/or if it turns out that you are node positive (particularly several nodes).
• Do you want to avoid hormone therapy (Tamoxifen or an AI) or Herceptin or chemo? It is very important to understand that if it's believed necessary or beneficial for you to have chemo or take hormone therapy, it won't make any difference if you have a lumpectomy or a mastectomy or a bilateral mastectomy.  (Note that the exception is women with DCIS or possibly very early Stage I invasive cancer, who may be able to avoid Tamoxifen by having a mastectomy or a BMX.)
• Does the length of the surgery and the length of the recovery period matter to you? For most women, a lumpectomy is a relatively easy surgery and recovery. After a lumpectomy, radiation usually is given for 6 weeks. A mastectomy is a longer, more complex surgery and the recovery period is longer. 
• How will you deal with the side effects from Rads?  For most patients the side effects of rads are not as difficult as they expected, but most women do experience some side effects. You should be prepared for some temporary discomfort, fatigue and skin irritation, particularly towards the end of your rads cycle. Most side effects go away a few weeks after treatment ends but if you have other health problems, particularly heart or lung problems, you may be at risk for more serious side effects. This can be an important consideration and should be discussed with your doctor. 
• Do you plan to have reconstruction if you have a MX or BMX? If so, be aware that reconstruction, even "immediate" reconstruction, is usually a long process - many months - and most often requires more than one surgery. Some women have little discomfort during the reconstruction process but other women find the process to be very difficult - there is no way to know until you are going through it. 
• If you have a MX or BMX, how will you deal with possible complications with reconstruction? Some lucky women breeze through reconstruction but unfortunately, many have complications. These may be short-term and/or fixable or they may be long-term and difficult to fix. Common problems include ripples and indentations and unevenness. You may have lingering side effects (muscle pain, spasms, itching, etc.) on one side or both (if you have a BMX). If you don't end up with symmetry (symmetry is not a sure thing by any means, even if you have a bilateral mastectomy with reconstruction done on both sides at the same time), will you regret the decision to remove your breasts or your healthy breast? Are you prepared for the possibility of revision surgery?
• How you do feel about your body image and how will this be affected by a mastectomy or BMX? A reconstructed breast is not the same as a real breast. Some women love their reconstructed breasts while some women hate them.  Most probably fall in-between. Reconstructed breasts usually looks fine in clothing but may not appear natural when naked. They may not feel natural or move naturally, particularly if you have implant reconstruction.  If you do choose to have a MX or BMX, one option that will help you get a more natural appearance is a nipple sparing mastectomy (NSM). Not all breast surgeons are trained to do NSMs so your surgeon might not present this option to you. Ask your surgeon about it if you are interested and if he/she doesn't do nipple sparing mastectomies, it may be worth the effort to find a surgeon who does do NSMs in order to see if this option is available for you (your area of cancer can't be right up near the nipple).
• If you have a MX or BMX, how do you feel about losing the natural feeling in your breast(s) and your nipple(s)? Are your nipples important to you sexually? A MX or BMX will change your body for the rest of your life and you have to be prepared for that. Keep in mind as well that even if you have a nipple sparing mastectomy, except in rare cases (and except with a new untested reconstruction procedure) the most feeling that can be retained in your nipples is about 20% - the nerves that affect 80% of nipple sensation are by necessity cut during the surgery and cannot be reconnected. Any breast/nipple feeling you regain will be surface feeling only (or phantom sensations, which are actually quite common and feel very real); there will be no feeling inside your breast, instead your breast will feel numb. For some, loss of breast/nipple sensation is a small price to pay; for others, it has a huge impact on their lives.
• If you have a MX or BMX, how will you deal emotionally with the loss of your breast(s)? Some women are glad that their breast(s) is gone because it was the source of the cancer, but others become angry that cancer forced them to lose their breast(s). How do you think you will feel? Don't just consider how you feel now, as you are facing the breast cancer diagnosis, but try to think about how you will feel in a year and in a few years, once this diagnosis, and the fear, is well behind you. 
• If you have a lumpectomy, how will you deal emotionally with your 6 month or annual mammos and/or MRIs?  For the first year or two after diagnosis, most women get very stressed when they have to go for their screenings. The good news is that usually this fear fades over time. However some women choose to have a BMX in order to avoid the anxiety of these checks.  
• Will removal of your breast(s) help you move on from having had cancer or will it hamper your ability to move on? Will you feel that the cancer is gone because your breast(s) is gone? Or will the loss of your breast(s) be a constant reminder that you had breast cancer?
• Appearance issues aside, before making this decision you should find out what your doctors estimate your recurrence risk will be if you have a lumpectomy and radiation. Is this risk level one that you can live with or one that scares you? Will you live in constant fear or will you be comfortable that you've reduced your risk sufficiently and not worry except when you have your 6 month or annual screenings? If you'll always worry, then having a mastectomy might be a better option; many women get peace of mind by having a mastectomy.  But keep in mind that over time the fear will fade, and that a MX or BMX does not mean that you no longer need checks - although the risk is low, you can still be diagnosed with BC or a recurrence even after a MX or BMX. Be aware too that while a mastectomy may significantly reduce your local (in the breast area) recurrence risk, it has no impact whatsoever on your risk of distant recurrence (i.e. mets).
• Do you know your risk to get BC in your other (the non-cancer) breast? Is this a risk level that scares you? Or is this a risk level that you can live with? Keep in mind that breast cancer very rarely recurs in the contralateral breast so your current diagnosis doesn't impact your other breast. However, anyone who's been diagnosed with BC one time is at higher risk to be diagnosed again with a new primary breast cancer (i.e. a cancer unrelated to the original diagnosis) and this may be compounded if you have other risk factors. Find out your risk level from your oncologist. When you talk to your oncologist, determine if BRCA genetic testing might be appropriate for you based on your family history of cancer and/or your age and/or your ethnicity (those of Ashkenazi Jewish descent are at higher risk). Those who are BRCA positive are very high risk to get BC and for many women, a positive BRCA test result is a compelling reason to have a bilateral mastectomy. On the other hand, for many women a negative BRCA test result helps with the decision to have a lumpectomy or single mastectomy rather than a bilateral. Talk to your oncologist. Don't assume that you know what your risk is; you may be surprised to find that it's much higher than you think, or much lower than you think (my risk was much less than I would ever have thought).
• How will you feel if you have a lumpectomy or UMX and at some point in the future (maybe in 2 years or maybe in 30 years) you get BC again, either a recurrence in the same breast or a new BC in either breast? Will you regret your decision and wish that you'd had a bilateral mastectomy? Or will you be grateful for the extra time that you had with your breasts, knowing that you made the best decision at the time with the information that you had?
• How will you feel if you have a bilateral mastectomy and no cancer or high risk conditions are found in the other breast? Will you question (either immediately or years in the future) why you made the decision to have the bilateral? Or will you be satisfied that you made the best decision with the information you had?

I hope that this helps. And remember.... this is your decision. How someone else feels about it and the experience that someone else had might be very different than how you will feel about it and the experience that you will have.  So try to figure out what's best for you, or at least, the option that you think you can live with most easily, given all the risks associated with all of the options.  Good luck with your decision!

Bren-2007

PRB .. Our stats are about the same ... small, Grade 2 tumor, ER/PR+, HR2-.  I chose a lumpectomy 6 1/2 years ago, and I'm still happy with that decision.  I also had radiation for 8 weeks.  My tumor was on the left side.  The only thing I might consider doing differently is foregoing the radiation.  My surgeon got 6mm margins all round my tumor and there was no lymph or vascular invasion.

It's a tough decision to make.  I pretty much knew right from the beginning that I would chose the lumpectomy. My sister said she would have chosen a total mastectomy.  Everyone is different ... we just do the best we can with the information we have.  Mine was more a gut level decision than a well thought out researched one.  It wasn't until after I started radiation that I really started doing a lot of research.

I wish you all the best making your decision.

hugs,

Bren

PRB1956

Thank you for these great replies.   I especially liked the one point that if chemo is required, it doesn't make any difference if you get a lumpectomy or masectomy.  I suppose that is because the chemo is destroying all the 'bad' circulating cells... which is the main concern and cause of a recurrence.

I am leaning towards a lumpectomy right now.  If after surgery the nodes are clean, then maybe a masectomy.  I'd like to avoid radiation if possible since I've had endometrial cancer in the past that only required surgery.

Thanks again.  This information will be a big help when I meet with my surgeon next week (and possibly the other clinic too).

ek25

PRB,

Thought I'd throw my two cents in here.  I was diagnosed with a tumor size very similar to yours, 5mm, ER+/PR-, HER2-, negative nodes.  My invasive tumor was mixed with DCIS, which led me down a very difficult path.  My invasive tumor was centrally located, but the DCIS was not.  I ended up having a lumpectomy, a lumpectomy with breast reduction and then finally, a double mastectomy with reconstruction.  I would just say that if you have DCIS involved here and have it in more than one place, it may be very difficult for your surgeon to get clean margins.  

As others have mentioned, if you have a risk averse personality and can't sleep at night thinking about this potentially coming back, then mastectomy is probably a way to address those fears.  It is not for the faint of heart, though.  It is a much tougher recovery than a lumpectomy and the reconstruction isn't fun.  And, I still worry about a recurrence even with them gone!  I didn't really have a choice, but if you do and you're okay with the chance of a recurrence at the breast, then I'd say go with the lumpectomy.

Best wishes.

sandcastle

If...you can get all your information.....and TRY to stay calm and filter people out......you will come to a conclusion of what YOU...want to do....Very hard to do......but you shall carry on....time helps so very much....right now it is more of a bad dream....my BEST.....Liz

keepthefaith

Your posts have been very helpful to me, as well. i have an appt with my BS and 2nd opinion MO on Thursday. I trust my BS to the fullest and have a great RO also. I guess if I decide on the LX, it wlll be monitored closely anyway. I am usually good with my gut feelings and I think, since this has been such an emotional roller coaster, they are not rearing their little heads! I will have to stop and breathe! Thanks again ladies, your encouragement and advice mean a lot!

Blessings2011

PRB1956 - so sorry you are faced with this choice. It's a tough place to be.

Thanks, ruth, for Beesie's very comprehensive post. All her points are valid.

I was dx'd in September 2011, with multifocal DCIS and IDC in my left breast. I was offered a lumpectomy with radiation, but the surgeon said she might have to take such a large wedge of tissue, the breast might be deformed, and I may prefer a unilateral mastectomy.

I chose a bilateral mastectomy for three reasons - 1) Mom had BC; 2) my Radiologist was VERY concerned about the dense tissue in the right breast, and 3) the Original Girls were huge, droopy, 38DDD, and I knew it would be difficult to match them up after a UMX.

Even though my IDC was very tiny and caught very early, I still did not know going into surgery whether or not I would need rads or chemo. If the margins were too close to the chest wall, I'd need rads. If there were any lymph node involvement, I'd most likely need chemo. Fortunately, I didn't need either one.

The reconstruction process was harder than the mastectomy. It was long, and at times frustrating. But today, I am still very happy with my decision (BMX and implants), and to be honest, the New Girls look pretty darn good!

SO much goes into making this decision, and my heart goes out to anyone faced with it right now. Just be good to yourselves, do your research, listen to your doctors, and follow your heart.

Whatever you choose, there are awesome women here who have gone down the same path.

Lissy2304

I was diagnosed June 29th of this year and I am currently recuperating from a double mastectomy. My cancer was 8mm on the left, ER+PR+ HER-. As a mammo tech for the last 19 yrs I see the anguish and worry in my patients when they come back for mammograms after their lumpectomies and treatment. I also see many recurrences and for that reason I chose a double mastectomy. It's not an easy surgery and the expanders I have in now are a pain! I won't have breasts for a while as reconstruction takes months, but I made that decision and I haven't looked back. Good luck with everything and God bless!

SelenaWolf

Stage 2, Grade 2, ER/PR+ HER2- 1/7 nodes, dense breasts.  No question, I wanted a lumpectomy.  I wasn't about to sacrifice more breast tissue than necessary.  Still have mammograms once-a-year, no more worry about them than I had pre-cancer.  Never looked back.  My biggest risk was not local recurrence, but distant recurrence, which a mastectomy would not have helped with.  Ergo, lumpectomy.  What will be will be.

It's a very personal choice, based on your pathology and your emotional response.

ruthbru

I really like having breasts, and I knew that I could never commit to the reconstruction process. I hate, hate, hate medical stuff and know that I could not bring myself to go through extra surgeries, pain, recovery, money, and, especially, time lost to more medical 'stuff'. So it was a lumpectomy or flat for me. I don't dread mammograms any more than before. And, as they can't remove every single drop of tissue, there are people who do get recurrences in the breast area, even with a mastectomy. So it is not a guarantee either way.

Sadly, it is a 'choose your own poison' type of deal. It is very smart of you to be thinking it through carefully before you make a decision. Pick the one you will be most comfortable with down the road, and then don't look back.

Annette47

I agree with the others - you have to do what feels right to you.

For me, I didn't want to lose my breast and since my area of cancer was tiny, there didn't seem to be much point to a mastectomy, especially since I had no particular reason to fear radiation (and in fact tolerated it quite well).

I do have a friend who had a bilateral mastectomy for a small area of DCIS 8 years ago who was recently diagnosed Stage 3 (new primary), so even removing both breasts, while it does of course drastically reduce the risk of dealing with this again, isn't a guarantee that it will never be an issue going forward.

I've only had one mammogram since treatment, and while I was of course a little nervous, it wasn't too bad.   I have another one coming up in December, and I anticipate a few days of anxiety right around it, but nothing I can't handle.

keepthefaith

thanks again Ladies....one worry with a MX or BMX is, how do they monitor and screen you in the future..? I think standard for LX is mammo/mri every 6 mos?

Annette, how was your friend recently diagnosed? I hope she does well through her treatment on beyond.

SelenaWolf

Standard for lumpectomy (in Ontario) is mammogram once-a-year, MRI only if there are concerning issues/symptoms.  MRI's are, normally, not routinely given as part of your follow-up; nor are bone scans or tumour marker blood tests for a number of reasons.

If you have lumpectomy/radiation, you cannot have a mammogram for - at least - six- to eight months following as the radiation in your breast will still be present and will "light up" the film.

Unfortunately, there is no set protocol for follow-up following a breast cancer diagnosis.  Every cancer centre/oncologist seems to have its own protocols as to what is standard procedure.  In the States, is the added complication of insurance companies and THEIR protocols.  "Monitoring" tends to come down to regular visits with your oncologist/doctor (every six months in the beginning, then every year thereafter) that include blood tests (i.e., WBC, RBC, Bilirubin, Kidney) if you are taking anti-hormonals, more if you are participating in a clinical trial; a physical/breast exam and that's it.  Additional tests/scans are, usually, not recommended unless the oncologist has concerns about new- or lingering symptoms. 

It sucks, but "monitoring" is, usually, just waiting to see if the cancer comes back or not.  You will need to ask your oncologist/treatment team what their particular follow-up protocols are and discuss what you are comfortable with (or not).

Annette47

She found a lump .... she had had a flap reconstruction (not sure exactly which kind) and I guess they weren't doing any kind of mammograms since they weren't considered breasts (the lump was at the outer edge of where the breasts had been).  

She's about half-way through chemo and doing well - thanks for asking!

As for follow-up after a lumpectomy, what I was told for me would be mammograms every 6 months for the first two years, switching to yearly after that.   I am also on 6 month appointments with the radiation oncologist, the surgeon, and my medical oncologist, so between them and my yearly gyn, someone is giving me a breast exam 4 times a year.   I'm not sure how long that schedule will keep up though ... 

ruthbru

I did mammos every 6 months for two years, then switched to yearly. I saw the radiologist and oncologist every six month for those two years also. After that, I continued to see my oncologist every six months until I hit the 5 year mark. Now I have graduated to once a year (I've scheduled my annual physical with my GP for 6 months after the oncologist appointment, so someone will still be tracking me every six months). I didn't meet with the surgeon ever again after the initial post-surgery follow-ups.

2FriedEggs

Truthfully I think this is something only you can decide after getting your doctors recommendations and evaluating what is most important to you. Good luck with your decision either way. Do your research, make your decision, and try not to second guess yourself.

keepthefaith

Thanks for your comments. I think my gut feelings are finally kicking in. I hope my gut and the Dr. agree now! We shall see. Whatever happens, I am going to make it through it!

My nurse navigator is going to send me the "standard of care" guidelines for follow up care, as written by the NCC.  So, I will be reviewing that tomorrow, I hope. Not that I will agree with it when it comes to my care, but at least I'll know what the Dr's (and insurance cos) want me to do, beforehand.

Have a good evening ladies! I will be thinking about you all~

msphil

I just want to give you my experience, as all are different, I was planning my wedding when diagnosed but I decided on the mastectomy, instead of lumpectomy and glad I made the decision now 19 yr SURVIVOR(PRAISE GOD) so I didn,t want to have to go back for another surgery. msphil(idc, stage2, L mast, chemo and rads and 5yrs on tamoxifen)

BeanBean

Very helpful information for me too. I have a lumpectomy (right) and reduction (left) scheduled for 10/17 and was beginning to think I should do mastectomy instead (4-5 cm original tumor and a satellite site of 8 mm). Given the large tumor size, I thought mastectomy would be my only option. but two surgeons have agreed lumpectomy is possible. Breasts will be signifanctly reduced in size after surgeries (which is fine).

keepthefaith

LNR,
My surgery (lumpectomy, SNB and port) is scheduled for the 18th and I wish it were sooner! I have one (aggressive) tumor that I want to get rid of yesterday!:). Then, chemo and rads, maybe HT...but, one step at a time!
Wishing you well on your surgery and recovery!
Please let us know.
HUGS!!!

BeanBean

KTF, sounds like we're on the same path. Not having port put in yet though. Hoping for node negative and low Oncotype score in order to avoid chemo. But, more than likely, it will be chemo, rads and HT.

Best wishes to you too!

keepthefaith

LNR, My first MO said he didn't think I needed an oncotype score based on my path report...I think he is recommending chemo anyway. My second MO (that I will be using) said she may order an oncotype score and thinks that it trumps all other factors. But, the kicker is, if my score is low, my insurance may not approve chemo. Not that I want chemo, but I sure don't want this to go elsewhere, if it can be prevented. I think she knows it will be high, but wants the whole picture. So, I have pretty much accepted that I will more than likely get chemo regardless of nodes, etc. Just bc of the aggressiveness of my tumor. My BS sent my path report to the tumor board at my cancer center and they all agreed that LX would be good for me. My hope is that the BS can get all of the tumor and clear margins, with a lumpectomy. My tumor is close to my chest wall...darn thing.
Good luck with your tests, etc.
Will be thinking of you all~

LAstar

My understanding is that, while the survival rate is the same for lumps+rads and MX, the recurrence rate is higher for lump+rads. See Table 2 of http://www.nejm.org/doi/full/10.1056/NEJMoa020989#t=articleResults.

keepthefaith

Thanks LAstar. My computer locked up trying to look at the article, but I did see that the study was done in 2002. We all have to make the best decisions for ourselves. I personally chose LX and if I need a MX later, so be it. One issue I had with the BMX was the follow up screening. I am in the hopes that the chemo will kick it's butt anyway! I have seen that LX w/rads has the same overall survival rate as MX, but not sure if that includes a chemo regimen with either or both. A lot of times with LX, there is rads and no chemo. I think I will be having both. If you don't mind me asking, was BMX your choice or something recommended after surgery?

LAstar

I had no choice after two unsuccessful lumpectomies -- the DCIS was too extensive. I did not want MX and did my darndest to avoid it! I agree that the follow-up screening options are not great after BMX. Some women get annual MRIs. Because I had DCIS and BMX, I can't find an oncologist who will see me unless my bones start hurting.

ruthbru

This is from an article from the research section of BCO it was published on January 29, 2013, so is current:

Lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk is about the same with either type of surgery.

A study suggests that in the real world, women diagnosed with stage I or stage II breast cancer who have lumpectomy followed by radiation have better survival rates than women who have mastectomy.

The study was published online on Jan. 28, 2013 by the journal Cancer. Read the abstract of “Survival after lumpectomy and mastectomy for early stage invasive breast cancer."

The researchers looked at the results of more than 112,150 California women diagnosed with stage I or stage II breast cancer between 1990 and 2004 who were treated with either lumpectomy plus radiation (55% of the women) or mastectomy (45% of the women). The women were followed through 2009.

The researchers compared overall survival rates and disease-specific survival rates between the two groups of women. Overall survival is how long the women lived, no matter what they died from. Disease-specific survival is how long the women lived before they died from breast cancer.

Overall survival was 19% higher for women who had lumpectomy plus radiation compared to women who had mastectomy. This suggested benefit wasn’t affected by the women’s age or the hormone-receptor-status of the breast cancer.

For women who had lumpectomy plus radiation compared to women who had mastectomy, disease-specific survival was:

• 14% better in women who were 50 and older and diagnosed with hormone-receptor-positive disease
• 7% better in women 50 and older and diagnosed with hormone-receptor-negative disease
• 12% better in women who were younger than 50 and diagnosed with hormone receptor-negative disease
• 6% better in women younger than 50 and diagnosed with hormone-receptor-positive disease

It’s not clear why women who had lumpectomy plus radiation had better survival rates than women who had mastectomy.

This study was a population-based study, which means the researchers used information that was collected before the study was planned. It also means that the women weren’t randomly assigned to get either lumpectomy plus radiation or mastectomy. So the women who got mastectomy may have had other health problems that may have affected the type of surgery they had. These other health conditions also may have affected their survival.