On deciding between lumpectomy or mastectomy TO YOUR HEALTH


June 22, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Several major scientific articles have indicated that for women with early stage breast cancer, a lumpectomy with radiotherapy offers the same rate of survival as a mastectomy for the surgical treatment of breast cancer.

It is surprising then that most American women with breast cancer still have mastectomies. The reasons for this are puzzling to scientists and are clearly complicated, but it points up the need to educate women about these issues so that they can make informed choices. I talked with Dr. Nancy Davidson from the Johns Hopkins Oncology Center about the decisions women must make after they have been diagnosed as having breast cancer.

Q: What are the options for surgical treatment of breast cancer?

A: If surgery is indicated for the treatment of breast cancer, there are two basic options -- a modified radical mastectomy (removal of the entire breast and lymph nodes in the armpit), or a lumpectomy with axillary dissection (removal of the cancer and lymph nodes in the armpit). Lumpectomies usually require breast radiotherapy, whereas most who choose mastectomies will not require radiation.

A lumpectomy allows a woman to keep her own breast tissue, thus eliminating the need to make decisions later about breast reconstructive surgery and breast implants.

Q: When is a lumpectomy indicated?

A: The National Cancer Institute recommends lumpectomies for women with stage I and II breast cancer; that is, breast cancers that are diagnosed when the tumor is less than 2 inches in diameter. More than 50 percent of diagnosed breast cancers fall into this category. Women who have had previous radiation to their chests may not be good candidates for lumpectomy with radiotherapy, nor will women who have cancer in several areas of the breast.

Q: How can I know that lumpectomy rather than a modified radical mastectomy will give an equally good result?

A: Over the last several decades, a number of studies have shown that the life expectancies for women who have lumpectomies with radiotherapy are the same as for those who have mastectomies.

These studies have involved thousands of women who have now been followed by researchers for up to 15 years, and those who have had lumpectomies followed by radiation do equally well. In fact, even women with larger tumors seem to do equally well with a lumpectomy.

These studies indicate that the choice of surgery is not the predicting factor for survival rates.

Q: How can a woman go about making this important decision?

A: You need to talk openly with you doctor and share information and responsibility for decisions. You may want to ask for a second opinion if you feel you need one.

For more information and support in making the decision, call (800) 4-CANCER.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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