A recent study revealed great news for women facing early-stage invasive breast cancer: choosing to preserve some breast tissue rather than removing the entire breast isn’t inviting more risk.
Survival Rate is Higher with Lumpectomy vs Mastectomy
Even when coupled with various factors – age, socioeconomic status, race, tumor grade, proportion of positive nodes and year of diagnosis – women were less likely to die with a lumpectomy.
For decades, the two surgeries were considered equivalent and mastectomies were the standard recommendation. There was even an apparent perception that mastectomies were more effective in treating breast cancer. Despite the new data, that mindset remains in some groups. Women who are eligible for lumpectomies are still getting mastectomies.
Of the 112,154 women who participated in the study, 94 percent who chose a lumpectomy and radiation between 1998 and 2004 had not died after 10 years, compared to 90 percent of those who had a mastectomy.
Of those studied, a total of 61,771 or 55 percent of the women received lumpectomies and radiation and 50,383 or 45 percent received mastectomies without radiation between 1990 and 2004. Of those groups, 25 percent who were 50 years or younger chose lumpectomies and 26 percent chose mastectomies. The women that went the mastectomy route were more likely to die within three years of their breast cancer diagnosis than women choosing lumpectomies.
Breast Cancer and Poverty
A disparity of wealth appears to play a role. Between 1994 and 2004, white women residing in wealthier areas were more likely to have lumpectomies. Although it seems counterintuitive, it’s less expensive to perform a mastectomy than a lumpectomy, according to the Cancer Treatment and Prevention Fund.
The reasons vary, but one contributing factor is some insurance companies consider lumpectomies an outpatient procedure and therefore don’t cover all related expenses. In addition to a more time-consuming surgery, radiation, rarely required for mastectomies, adds to the cost.
In one study, conducted in a large urban hospital primarily serving an indigent population, only 16 percent of eligible patients received lumpectomies. Another study reported low rates of lumpectomies among uninsured women.
Limitations of the Study
As with most studies, there are a few limitations. One issue is there were unmeasured variables that could have accounted for the higher number of deaths associated with mastectomies.
For example, patients with limited access to medical care, which tends to contribute to an overall higher mortality and disease-specific mortality rate, are more apt to receive mastectomies. In addition, women with larger tumors are more likely to undergo a mastectomy in the first place and because their tumors are larger to begin with, the likelihood of them dying from breast cancer is higher.
There are clearly limitations inherent in the study since the data used employed a large population. Cancer registries, such as the California Cancer Registry, are not equipped to collect data that includes other preexisting conditions the patient may have, detailed pathologic data or individual patient and provider biases, all of which may affect treatment choices.
Lumpectomy vs Mastectomy
So what does all this mean to women navigating surgery options and considering a lumpectomy vs mastectomy?
In the past, a mastectomy may have seemed inevitable. You may have reasoned that it was safer to entirely remove your breasts. Yet, the results of this study reveal that long-term breast cancer survival after a lumpectomy is equivalent, or even superior, to a mastectomy in all age groups.
Still, there are many variables at play with a breast cancer diagnosis. Ages, cancer stage, tumor type and size, among other factors, are all pieces of the puzzle in deciding which treatment route to take.
In some cases, a mastectomy may be the most viable option. Whether you need a lumpectomy or a mastectomy is only something you and your physician can decide. Please talk to your physician about your options and what he or she thinks is the best course of action.