Mastectomy with Recon. or Lumpetomy with RAD?

yorkiemom, it's not standard treatment but I believe some women choose lumpectomy and no radiation.  Obviously, the risk of recurrence would be higher without rads. I believe the women who chose this were grade 1 with very small tumors. (5 mm or even less?) And in that case, I think you'd want the BS to get very good margins.

FWIW, I was worried about the SE of rads myself and got really stressed out by the decision-making process. So good luck with your decision making process. 

Sometime to consider from the BCO research page a couple weeks ago.

Adding Radiation Cut Breast Cancer Recurrence in Half

For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy has been shown to be as effective as mastectomy without radiation for removing the cancer AND minimizing the risk of the cancer coming back (recurrence). Doctors call radiation therapy given after surgery adjuvant radiation therapy or adjuvant radiotherapy. Adjuvant radiation therapy can destroy any cancer cells that may have been left behind after surgery, making recurrence less likely. Almost all women get adjuvant radiation therapy after lumpectomy. Most doctors believe adjuvant radiation therapy's greatest value is to reduce the risk of the cancer coming back in the breast area (locoregional recurrence).

A very large study has found that radiation therapy after lumpectomy offers more benefits and keeps offering benefits much longer after diagnosis than doctors realized. Recurrence risk was cut in half when adjuvant radiation therapy was included in the treatment plan for women diagnosed with early-stage breast cancer who had lumpectomy. Adjuvant radiation therapy also reduced the risk that the cancer would come back in parts of the body away from the breast (metastatic recurrence) -- not just locoregional recurrence risk -- and improved long-term overall survival. The results were published in the Oct. 15, 2011 issue of The Lancet.

A meta-analysis is an analysis of the results of a number of completed studies. This meta-analysis looked at 17 studies on the benefits of adjuvant radiation therapy after lumpectomy involving more than 10,000 women; the 17 studies compared the outcomes of women who got adjuvant radiation therapy to women who didn't. Half of the women were followed for more than 9.5 years and the others were followed for a shorter time. Some of the women were followed for more than 20 years.

In the 10 years after surgery:

• 19.3% of women who got adjuvant radiation therapy had a cancer recurrence
• 35% of women who didn't get radiation therapy had a recurrence

In the 15 years after surgery, researchers projected that:

• 21.4% of women who got adjuvant radiation therapy did or would have a recurrence and die as a result
• 25.2% of women who didn't get radiation therapy did or would have a recurrence and die as a result

The results mean that for every four recurrences prevented by adjuvant radiation therapy, one death from breast cancer also would be prevented.

It's important to know that many of the women followed in the 17 studies analyzed had clear lymph nodes, meaning the cancer hadn't spread to nearby lymph nodes. These women were considered at low risk for breast cancer recurrence. Still, the results strongly suggest that adjuvant radiation therapy after lumpectomy can reduce the risk of recurrence and improve survival for all women diagnosed with early-stage breast cancer, no matter their estimated risk of recurrence at the time of surgery.

The results also strongly support doctors' current understanding that lumpectomy followed by radiation therapy is a very good alternative to mastectomy for many women.

If you've been diagnosed with early-stage breast cancer, you and your doctor will consider the characteristics of the cancer, your unique situation, your surgical options, and your treatment options after surgery when creating your treatment plan. If you choose lumpectomy, it's very likely that radiation will be recommended after surgery. If radiation therapy isn't recommended, you may want to talk to your doctor about this study and ask why adjuvant radiation therapy isn't recommended for you.

yorkiemom,

you said " I was surprised that it is EVER ok to have a lumpectomy and no rad."   Lumpectomy with no rad may not be advisable in your situation.  Sometimes with DCIS radiation will not be needed with lumpectomy.    (low grade, small tumor, with good margins, etc).   the idea is that the expected reoccurance rate for some people is already pretty low. There are a number of factors to consider.

I dont know the standards for other types of BC. 

http://www.theeffectivetruth.info/wksht1.html

I had a lumpectomy and rads with no problems what-so-ever. I was thrilled to be able to have breast conserving surgery (as there are a lot of potential bad SE with the more major surgery of a mastectomy, and if you want reconstruction, then you will be dealing with a lot more time, pain, money, possible negative SEs from that too). I was glad to have rads also, because I never want to play this game again!!!!!

"My tumor is about 1 cm., lobular invasive, Grade 1. From what I've read and heard I will definitely need rads with a lumpectomy."

That's certainly what will be recommended. If you had only DCIS, no invasive component, you MIGHT have been told that rads are optional, but once there's invasion they want to do rads.

Age is another component. The younger you are, the more it's recommended to be to treat BC aggressively. 

Hi yorkiemom



My options were to stop after the lumpectomy and have rads, or to procede with a mastectomy with recon. I choose the latter. Its been a long year, but Im definitely sure for me it was the right decision. It came down to the fact that i would rather live with a foob, than keep the original and worry about recurrence.



Its such a personal choice and so dependant on individual circumstances, but my docs were totally supportive.



Good luck with your choice x

"For the first time in my life, being older seems better."

Breast cancer treatment and senior discounts -- two of the very few, positive aspects to getting older! 

Has anyone had mastectomy and reconstruction with implant (or other form of reconstruction) before radiation? My oncologist insists I do radiation so I am looking to do prophylactic mastectomy first, but I understand there can be damage to the implant and complications.