Confused? recurrence risk lumpectomy + radiation vs. mastectomy

Paisienmom

I had a lumpectomy in April due to IDC, HER 2, ER+, PR+, and I am finishing my last chemo (TCH) next week. After my chemo, I can have a mastectomy if I decide I don't want to go through radiation. My surgeon and oncologist explained that my risk of recurrence would be better if I go through lumpectomy and radiation. I did some research again before going through radiation and I read that mastectomy would have a lower risk of recurrence. I'm really confused! If I go through a mastectomy, it would be just my left breast!

Meow13

I think it is just about the same risk mastectomy vs lump and radiation.

emiliemk

I just joined this site. I don't know the answer to your question. I'm an MD and a psychiatrist. But I did next to nothing to research breast cancer when I was diagnosed in 2012. I've still done very little. I'm pretty much doing what has been recommended. I wasn't told I could have a mastectomy or a lumpectomy with radiation. I was told the surgical treatment was lumpectomy and radiation. (chemotherapy came after surgery for me, followed by radiation). That's what I did. I read more about cancer after everything was done. I read one book about the history of cancer.

One thing might help you decide. If mastectomy is removal of breast tissue only (no chest wall, no lymph nodes), maybe it will be simple. I don't know if it will be more effective than radiation. For a long time, the standard of care was the Halstead radical mastectomy and "lumpectomy" was the derisive term coined by American doctors critical of the British (I think) doctor who found success in removing a much smaller amount of tissue. I think he combined it with radiation. A lot of women suffered with removal of much more of their body than necessary - for years after it was no longer necessary. So if you are reading about mastectomy, it might help you to know from your doctors, what they would remove exactly. Is it more than breast tissue? And what they believe radiation would be getting at that a mastectomy wouldn't. I'm sorry this is so long. I hope it helps.

ChiSandy

The theoretical risk of recurrence after mastectomy is 3%, while that of lumpectomy plus radiation is listed at 6%. But studies have shown that recurrence aside, the overall survival (i.e., life expectancy, or time until death from all causes) for both options is equal (in fact, it's a little better for lx+rads because less invasive surgery is involved). But be advised that even with mastectomy, radiation may still be necessary if the nodes are involved or the tumor is close to the chest wall. And some women get even bilateral mastectomies yet still develop recurrences in whatever small amount of tissue had not been removed. I opted for lumpectomy + rads because of the tumor's small size relative to my breast, favorable profile, and convenient location. I am glad I did. I don't think that mastectomy would give me any greater peace of mind, simply because I've heard all the cautionary tales about those who threw "everything in the book" at their cancer and it still came back. At 65, what happens happens.

The days of the modified radical mastectomy (breast and all axillary nodes but stopping short of the pectoral muscle) are not so long ago--most of us of a certain age remember (even well into the 1980s) when it was a given. In fact, as recently as the mid-'70s, all breast cancers were considered so fast-growing that surgeons believed it was dangerous and foolhardy to do a biopsy first and then schedule surgery later if the tumor (usually a lump found by the patient--mammography wasn't widely available yet) proved malignant. What happened when a patient found a lump or other suspicious phenomenon (dimpling, nipple inversion, discharge) was that surgery was scheduled, the patient signed a consent for biopsy and mastectomy, was put under and an excisional biopsy was performed. A “frozen section" was sent to the path lab for immediate evaluation. If benign, the incision was sutured and the patient told the good news when she came to. But if malignant, a modified (or even Halsted) radical was done, and the patient's first news of her diagnosis came when she awakened minus her breast. And never mind that not a single lymph node may have been involved--they were all removed first and then biopsied. No such thing back then as SNB. Everyone got radiation and most got the most brutal chemo as well--no hormone-receptor testing, no OncotypeDX testing. And most of the drugs that are routinely given chemo patients today to boost immunity and combat nausea were not given back then.

All that (except the chemo) happened to my MIL at 63, back in 1974. She found an inverted nipple, went to her gyne, was immediately admitted to the hospital and woke up with her breast and all her axillary nodes removed. She spent a week in the hospital had weeks of “Reach to Recovery" range-of-motion physical therapy, followed by more weeks of radiation to the chest and armpit. She recovered and lived to almost 96--but had she faced the same situation today, a core needle biopsy and tumor profiling pathology would have been performed, she'd have been given time to weigh her options, make a decision and choose a surgeon and oncologist; a lumpectomy, SNB and radiation would have been performed, she'd likely have been spared invasive and disfiguring surgery, gone home the same day and been given just tamoxifen or an AI for 5 years. I am certain that modified radical and extensive radiation took its toll on her body, and less invasive surgery & therapy might have made the rest of her life more robust and vigorous.

Even those of us who do get mastectomies and chemo have it easier than our mothers and grandmothers did.

emiliemk

I just read ChiSandy's response. She didn't tell you what to do, but if I had written your question, and recognizing how easily my head spins, I would use her response to allow me to lean into the decision of radiation to follow the lumpectomy I already had.

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ShetlandPony

I will echo ChiSandy's first paragraph. Get your doctors to clarify about local recurrence (breast) risk versus distant recurrence (metastasis) risk. I think there is a small increase in local recurrence risk with breast conserving surgery since the breast is still there. (I was willing to accept that in exchange for keeping my breast.) Distant recurrence is the greater concern. That's where they say the risk does not differ for lumpectomy + radiation vs. mastectomy. However, I believe some recent data and studies have shown slightly better metastasis-free survival results for lumpectomy + radiation, perhaps because of avoiding the systemic effects (such as inflammation) of more extensive surgery and anesthesia and/or because with whole breast radiation some axillary nodes are in the treatment field. It is important to get medical advice on your specific situation.