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Myths of Breast Cancer Surgery

The Truth About Benefits of Surgery for Breast Cancer

By Maureen Salamon

Updated December 05, 2008

(LifeWire) - Information on breast cancer and its treatment has never been more prolific, but even with the vast resources of Internet data and public awareness campaigns for national cancer organizations, myths about breast cancer continue to persist.

Many misconceptions center on breast cancer surgery. Since nearly all 240,000 U.S. women diagnosed with the disease each year will have undergone some form of surgery, these myths need to be addressed.

Here are some of the most prevalent misconceptions about breast cancer surgery and the facts that repudiate them:

Myth: A lump must be surgically removed to determine if it's cancerous.

Fact: There are ways other than surgery to find out if the tissue is malignant, including a minor procedure performed right in the doctor's office. A needle biopsy is made by extracting a tiny portion of the mass for lab analysis.

Myth: Mastectomy is the only option for treating breast cancer.

Fact: Mastectomy — surgical removal of the entire breast — is just one of a wide range of treatments available, including breast-conserving surgery or "lumpectomy", chemotherapy, radiation and hormone and immunological therapies.

Myth: Surgery can cause cancer to spread.

Fact: "There's not a teeny bit of truth about it," says Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society in Atlanta. Surgery is one of the best ways to control breast cancer, but sometimes during an operation, the doctors may discover that the malignancy has spread farther than initially believed. There's no scientific evidence, though, that tumor cells can spread during surgery.

Myth: Surgeons may remove my entire breast during a biopsy without my consent.

Fact: Patients sign an informed consent form prior to biopsy surgery that explains the procedure that the surgeon will follow. If the tissue removed is found to be cancerous, doctors will discuss further treatment options with their patients before proceeding. Decades ago, before advances in breast imaging and other cancer detection methods, surgeons might have progressed directly to mastectomy if a biopsied mass was found to be malignant during surgery. That no longer happens.

Myth: Mastectomy has a higher survival rate than lumpectomy plus radiation.

Fact: For smaller tumors, these two methods are equally effective. In the early 2000s, scientists established that those who underwent lumpectomy and radiation, which saves the breast but follows up with radiation to the surrounding breast tissue, were just as likely to be alive 20 years later as those who had, had a mastectomy. Doctors often give patients with smaller tumors a choice between the two treatments. About 60% choose lumpectomy, while the balance opt for the more radical surgery, according to Saslow. Lumpectomy, though, may not be an option in the case of larger tumors or those that — because of their location — can't be removed with the several millimeters of healthy breast tissue needed for what are termed "clear margins."

Myth: Women with a family history of breast cancer shouldn't consider lumpectomy.

Fact: Family history has no bearing on how the disease should be treated. When diagnosed, only about 10% of breast cancer patients report that a relative has also had the disease or have tests showing that they carry genes predisposing them to breast cancer. How aggressively their doctors treat them depends on the stage and scope of their disease and how strongly patients wish to respond, not based on other factors.

Myth: Undergoing prophylactic (preventive) mastectomy protects a woman from developing breast cancer.

Fact: Women at a very high risk for breast cancer (for example, because they carry the BRCA gene or have an unusually strong family history) sometimes decide on prophylactic surgery to prevent breast cancer from ever occurring. For about 90% of them, it won't, says Dr. Saslow. Technically, though, breast tissue extends to the collarbone and underarm areas, and as long as any of it remains, breast cancer is still possible, but remote.

Myth: Having a mastectomy guarantees the cancer won't return.

Fact: No treatment can provide this guarantee. A few women experience a recurrence of breast cancer near the scar of the removed breast, whereas others will develop cancer in the opposite breast. In addition, between 30 and 85% of women whose cancer had already advanced to the lymph nodes before mastectomy surgery will eventually suffer a metastasis, or distant spread, of their cancer if systemic therapy, such as chemotherapy or hormone therapy, is not used.

Myth: Lymph node removal leads to lifelong swelling in a patient's arm.

Fact: Breast cancer surgery typically includes lymph node removal — from a single node to many — because analyzing them for malignant cells is one of the best ways to determine whether the cancer has spread. Swelling, known as lymphedema, is one possible side effect of lymph node removal is 20% or so for a full node dissection and 2 to 5% for sentinel procedures. The more lymph nodes removed, the higher the risk of lymphedema. The symptoms, though generally temporary, can last a long time. Besides swelling, these can include numbness and discomfort. There are steps, however, such as post-surgical exercises or the use of compression sleeves, that can help with this condition.

Sources:

"16 Common Myths About Breast Cancer." umich.edu. 26 Sep. 2006. University of Michigan. 21 Jul. 2008.

"Breast Cancer." mdanderson.org. 2008. M.D. Anderson Cancer Center. 23 Jul. 2008.

"Mastectomy No Better Than Lumpectomy for Women with Small Breast Tumors." cancer.gov. 23 Oct. 2002. National Cancer Institute. 25 Jul. 2008.

McGarvey C.L., N.L. Gergich, P. Soballe, L. Pfalzer. "A Case Report: Breast Cancer Metastasis and Implications of Bony Metastasis on Activity and Ambulation." Rehabilitation Oncology. 2006;24(1):4-17.

"Surgery." breastcancer.org. 5 Aug. 2008. Breastcancer.org. 21 Jul. 2008.

Saslow, Debbie, Ph.D. Telephone interview, 3 Jul. 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a New Jersey-based freelance writer who has written for newspapers, websites and hospitals.
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