Managing Treatments

Mastectomy vs. Lumpectomy for Early-Stage Breast Cancer

Choosing the right surgery to treat your early-stage breast cancer is a big decision. Talk to your surgeon about mastectomy vs. lumpectomy to make certain you're well-informed about your treatment options.

Being diagnosed with breast cancer, even at an early stage, is terrifying. You can take comfort in statistics from the American Cancer Society, showing that 99% of women with cancer confined to the breast survive at least 5 years. Nearly all women with early-stage breast cancer will be advised to undergo surgery — either a lumpectomy or a mastectomy. One decision you’ll make after diagnosis is choosing between mastectomy or lumpectomy.

Two of Your Options

Mastectomy is a surgical procedure that involves the complete removal of your breast tissue. Many women will opt to undergo additional surgery to reconstruct the breast either immediately or months after their mastectomy. Although this approach involves more surgery than lumpectomy, many women are adamant about choosing it because of fear of recurrence. Removal of the entire breast decreases the risk of breast cancer recurrence and can provide you a feeling of security.

Lumpectomy, also called breast conservation surgery, involves removing only the tumor and some surrounding breast tissue, according to the American Cancer Society. It’s often chosen by women with a desire to keep their breast. This procedure not only has an easier recovery but it reduces the need for breast reconstruction. While these are attractive advantages, some don’t choose lumpectomy because they worry the cosmetic outcome of lumpectomy may be unacceptable. The breast may seem lopsided or not match the other breast. This factor is more of a concern in women with larger tumors. Women who find the cosmetic outcome unacceptable may need to go through a reconstructive surgery to correct it.

Several weeks of radiation therapy is usually recommended after lumpectomy to try to decrease the risk of breast cancer recurrence. Besides being time-consuming, radiation therapy can cause damage to nearby healthy tissues.

Recent Research Provides Insight

When considering mastectomy vs. lumpectomy, one of the primary reasons you may choose mastectomy is because it appears to be the conservative choice. The results of a recent clinical study call this into question. A study published in The Lancet Oncology examined the survival outcomes of over 37,000 women undergoing either lumpectomy plus radiation therapy or mastectomy. It turns out the women undergoing lumpectomy and radiation had better survival than those undergoing mastectomy. There were certain confounding factors (such as the fact that women with smaller tumors and better expected outcomes chose lumpectomy more often) indicating that the true impact of lumpectomy may be more modest, but the authors suggest lumpectomy provides survival that’s at least as good, maybe longer, than mastectomy.

Which to Choose: Mastectomy vs. Lumpectomy

If you’re facing early-stage breast cancer and need to decide which surgery is right for you, talk through the advantages and disadvantages of each with your surgeon. In addition, consider the following questions. The answers are personal to you and there are no “correct” responses:

  • How important is it to you to keep your breast?
  • How do you feel about the possibility of reconstructive surgery?
  • How important is the cosmetic outcome of surgery, particularly breast symmetry?
  • How do you feel about radiation therapy?

Although this is a difficult decision to make, keep in mind your well-being regardless of your chosen path.

Are you concerned about breast cancer or the options available to you if diagnosed? Your first step is to get screened to ensure your health. Discuss your surgical options with on of UVA's breast surgical oncologists if you have questions.

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Jennifer Klem, PhD