For early breast cancer, lumpectomy is at least as good as mastectomy

When it comes to fighting cancer, “get it out” is a common and understandable response. It’s what prompts some women with early-stage breast cancer to choose mastectomy, an operation to remove the entire affected breast. Results from the largest-ever observational study offers reassurance to women who choose a more conservative approach—removal of just the tumor and some tissue around it (lumpectomy) followed by radiation therapy. In fact, the new study suggests that in a group of 112,000 women, those who had lumpectomy plus radiation therapy survived longer than those who underwent mastectomy.

In describing a study like this, details matter. So bear with me for a moment. The study included 112,514 women diagnosed with and treated for early-stage breast cancer between 1990 and 2004—55% chose lumpectomy and radiation, 45% chose mastectomy. All of the women were listed in the California Cancer Registry, which collects information on almost all Californians diagnosed with cancer. Researchers followed the women for an average of nine years after their diagnosis and treatment.

Over the course of the study, 31,416 of the women died, 39% from breast cancer and the rest from other causes. As a group, women who chose lumpectomy plus radiation had lower death rates from breast cancer and all causes than women who chose mastectomy. The women who appeared to reap the biggest survival benefit from lumpectomy plus radiation therapy were those over age 50 with estrogen-positive breast cancer, with 13% lower mortality from breast cancer and 19% lower for all causes. The results were reported online today in the journal Cancer.

Supporting choices

Back in 1990, a National Institutes of Health consensus panel concluded that lumpectomy followed by radiation is as good as mastectomy for early-stage breast cancer. For personal and medical reasons, many women choose to have the bigger procedure. And the number of women having mastectomies has risen recently. For early-stage breast cancer, mastectomy has been proven to cure or at least retard the disease. It’s a reasonable and understandable choice, especially given how well breast surgeons today can reconstruct a breast.

For women who choose to have lumpectomy plus radiation therapy, the new study provides yet more scientific reassurance that this approach is at least as good as mastectomy.

The results must be taken with a small grain of salt. This was not a randomized trial, the gold standard of medical research, in which women were randomly assigned to one treatment or the other. Instead, each woman and her doctor decided on the treatment strategy. It’s possible that women who chose mastectomy were less healthy or at higher risk of having an aggressive type of cancer, and that’s why women who chose lumpectomy plus radiation seemed to do better.

Lumpectomy plus radiation therapy isn’t the best choice for all women with early-stage breast cancer. Reasons to opt for mastectomy include:

• A breast tumor that is between 4 and 5 centimeters in diameter. This is close to the upper size for an early-stage cancer.
• Being at high risk for developing complications from radiation or the inability to undergo radiation therapy
• A strong family history of breast cancer or presence of a known genetic mutation that significantly increases the risk of developing breast cancer again.

It’s great to have choices for treating early-stage breast cancer. And more advances are sure to come. But having options can sometimes be stressful. For a woman newly diagnosed with breast cancer, it pays to take some time thinking about your options and talking with your doctor and other trusted individuals about them.