Mastectomy no more likely to prevent mets than a lumpectomy?

Hi!

It's important to remember that cancer can be a systemic disease. We often think of it spreading through the lymph system, but it can also spread through the bloodstream. After all, for a cancer lesion to survive, it needs a blood supply. So, yes, even if you're Stage 1 and have clear nodes, there's always a very small chance that your cancer could spread that way. Also, remember that for mets or local recurrence, stage may not be as important as grade or what kind of cancer you have (HER2+? Triple positive? Triple negative? Hormone positive? Hormone negative?). Some cancers are just more aggressive than others, regardless of size and nodal involvement.

I think the formulation in question is that mastectomy is no better than lumpectomy + radiation at preventing mets. However, it should be noted that mastectomy is slightly better than lumpectomy + radiation at preventing local recurrence (another cancer in the breast area) because there's less breast tissue left afterwards. But, even if you have a mastectomy, that's no guarantee that you won't have a local recurrence. Best wishes!

To add to ElaineTherese's post....the important thing to understand is that in most cases, it's believed that breast cancer has been in the breast for anywhere from 3 to 10 years before it becomes large enough to be detected. So even an early stage breast cancer has likely been in the body for years, and during that time, it's possible that just a few cancer cells might have moved away from the primary tumor and entered the bloodsteam, moving from the breast into a different part of the body. Sometimes those rogue cells don't take hold and/or die off on their own. Or they might be killed off by hormone therapy (given to those who are ER+), Herceptin (given to those who are HER2+), or chemo (given to those who have aggressive cancers and a high risk of mets). But none of these treatments are 100% effective, so in some cases those rogue cells take hold and at some point start multiplying, leading to the development of mets.

The key point is that when this happens, the start of this process most often occurred well before the patient even knew she had breast cancer. Most women who develop mets don't have a localized recurrence (i.e. a recurrence in the breast area) first. The breast cancer in the breast in fact has been successfully treated, yet they still get mets. This is because the cancer cells that developed into the mets escaped the breast and moved into the body before the cancer in the breast was removed (surgery) and treated (rads, where necessary). And this is why a mastectomy is no more effective than a lumpectomy + rads in reducing the risk of mets. I don't much like this analogy, but a MX is kind of like closing the barn door after the horse has escaped. (As a side note, this is also why if a cancer is aggressive enough to require chemo, chemo will be recommended regardless of whether the patient had a lumpectomy or a MX. Having a MX doesn't get anyone out of chemo, if chemo is judged to be necessary.)

Of course there are some exceptions - women who do develop mets as a result of a localized recurrence. But this happens rarely enough that it doesn't change the numbers that show that overall, there is no difference in survival rates between a lumpectomy + rads vs. a MX. (Some recent studies have actually shown a higher survival rate for those who have a lumpectomy + rads).

All that said, most women with Stage I breast cancer never develop mets, regardless of the type of surgery that they have. In your case, with a small grade 1 cancer that is ER+/PR+ and HER2-, the risk that some rogue cells might have moved into your body is very small, particularly if your surgery confirms that you are node negative (an ultrasound of the nodes is not a definitive finding). One option is to ask your oncologist whether it's appropriate that the Oncotype test be done on your removed breast tissue (after surgery). This is a test that assesses the genetic make-up of the cancer to determine the aggressiveness of the cancer and the risk of mets, and therefore whether or not chemo might be beneficial. That would be the one additional piece of information, beyond grade, hormone status and HER2 status, that might be helpful to you

My cancer was multi-focal. Mastectomy was my only surgical option.

Is your cancer Lobular or Ductal Icantri?

hello sweetie was making wedding plans when diagnosed its my 2nd marriage so i didnt want to go into this marriage not whole but instead of lumpectomy went 4 mastectomy am now 22yr Survivor Praise God. msphil idc stage 2 Lmast chemo before n after rads n 5yrs on tamoxifen

Re the remark: "One generally does not need radiation if they undergo mastectomy except in cases of large or multiple aggressive tumors, or 3 or more positive lymph nodes."

I would emphasize that this is a generalization, and is not a complete statement of the factors and indications for post-mastectomy radiation. For example, margin sizes are an additional consideration for post-mastectomy radiation under NCCN Guidelines for Breast Cancer (Version 2.2016; Chart BINV-3, "LOCOREGIONAL TREATMENT OF CLINICAL STAGE I, IIA, OR IIB DISEASE OR T3, N1, M0"). Also, under NCCN Guidelines applicable to invasive breast cancer, post-mastectomy radiation is considered with "1–3 positive axillary nodes" (Chart BINV-3).

ASCO has recently issued a relevant guideline regarding post-mastectomy radiation therapy ('PMRT") for certain types of invasive disease, which supports an individualized case-specific risk/benefit approach. As noted by ASCO: "Thus, the decision to recommend PMRT requires a great deal of clinical judgment."

"Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update" - Invasive disease setting

http://ascopubs.org/doi/full/10.1200/JCO.2016.69.1188#ref-3

Guidelines should be used for background only and are not a substitute for expert medical advice. The question of post-mastectomy radiation therapy is a specialized area within the expertise of Radiation Oncologists ("RO"), and patients should seek a referral to an RO to obtain accurate, current, case-specific expert professional medical advice.

BarredOwl