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A newly published study confirms previous findings which show that women who are diagnosed with early stage breast cancer have equal chances of surviving disease, regardless of whether they undergo a lumpectomy (followed by radiation therapy) or a mastectomy. For over a decade, the National Institutes of Health has recommended that women with early stage breast cancers be offered the option of either lumpectomy and radiation therapy or mastectomy. Yet despite this recommendation, more mastectomies than lumpectomies are still performed on early stage breast cancer patients. A lumpectomy is a type of breast-conserving surgery in which only the breast tumor and a surrounding margin of normal breast tissue is removed. A mastectomy involves removing much more breast tissue. Though there are different types of mastectomy procedures, they all involve removing most of the breast. Many women who undergo a mastectomy have reconstructive surgery (often with breast implants) to rebuild the appearance of the breast after treatment. The latest study was published in the August 15, 2003 issue of Cancer. In the study, Dr. Matthew M. Poggi of the National Cancer Institute and colleagues followed 237 women who had been diagnosed with early stage breast cancer for an average of 18 years. Each of the women either underwent a modified radical mastectomy, in which most of the breast was removed, or a lumpectomy with lymph node removal, followed by radiation therapy. The results showed equal survival rates among the two groups of women: 58% with mastectomy and 54% with lumpectomy/radiation. This adds to a body of evidence to support equal survival rates among early stage breast cancer patients, regardless of which type of surgery they choose to undergo. For example, in a study published in October 2002, Umberto Veronesi, MD from the European Institute of Oncology and colleagues from Milan, Italy followed 701 women with breast cancers measuring less than two centimeters in diameter. All of the women had either lumpectomy followed by radiation therapy or mastectomy. Additionally, some of the women had lymph nodes removed and received chemotherapy. Chances of survival were equal, regardless of surgery type. In another study, begun in 1976, Bernard Fisher, MD and colleagues from the National Surgical Adjuvant Breast and Bowel Project at the University of Pittsburgh, analyzed data from women who underwent mastectomy, lumpectomy, or lumpectomy with radiation. The aim of the study was to assess treatment options for women with invasive breast cancer. Fisher and colleagues also found that women who underwent lumpectomy plus radiation were just as likely to survive breast cancer as the mastectomy patients. The researchers concluded that radiation therapy following lumpectomy continues to be an "appropriate treatment option" for women with breast cancer so long as a margin of normal breast tissue is removed around the breast cancer tumor and that the cosmetic results of the surgery are acceptable. Though studies appear to provide a consensus that early stage breast cancer patients can often choose between mastectomy and lumpectomy (with radiation), women should weigh the advantages and disadvantages of both lumpectomy and mastectomy with their cancer treatment team to determine which treatment is best for them. Lumpectomy may preserve the physical appearance of the breast but usually requires six to seven weeks of radiation therapy. Mastectomy may reduce the chances of a local recurrence of breast cancer but additional decisions about breast reconstruction are introduced. Also, some women may be better candidates for mastectomy than lumpectomy or vice versa depending on their individual medical situation.
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