Breast Cancer Surgery: Less Better than More?

Women with early stage breast cancer who undergo breast-conserving surgery do just as well, and perhaps better, in terms of survival, than those who have their breasts removed.
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Women with early stage breast cancer who undergo breast-conserving surgery do just as well, and perhaps better, in terms of survival, than those who have their breasts removed, a new study suggests.

In the study, early stage breast cancer patients who were treated with lumpectomy — a surgery that removes the tumor and part of the surrounding tissue — were 19 percent less likely to die from any cause over a nine-year period compared with those who received a mastectomy.

The advantage was seen even after researchers took into account factors that could affect survival, such as age, size of the tumor before surgery, and the aggressiveness of the cancer.

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However, experts caution the apparent survival benefit might have been due to differences between the two groups of women that the researchers were not able to take into account, such as access to health care.

Regardless of this issue, the study provides reassurance to breast cancer patients who opt for more conservative surgery. In recent years, mastectomies have risen among certain groups of patients, such as young women, the researchers said.

Many women think "they may do better the more surgery they do," said study researcher Dr. E. Shelley Hwang, chief of breast surgery at Duke Cancer Institute. "They need to be aware that lumpectomy gives them excellent long-term outcomes."

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The researchers note lumpectomy is not for everyone. It is not recommended for women with large tumors or multiple tumors in the same breast, those who have had previous chest radiation, or those who have certain genetic mutations, such as the BRCA1 mutation. But the majority of women diagnosed with early stage breast cancer (over 80 percent) are candidates for lumpectomy, Hwang said.

Breast Cancer Surgery

Hwang and colleagues analyzed information from 112,154 women in California diagnosed with early stage breast cancer between 1990 and 2004 who received either a lumpectomy followed by radiation, or a mastectomy.

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