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Should I have a mastectomy or a lumpectomy for early-stage breast cancer?

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Updated July 31, 2009

Question: Should I have a mastectomy or a lumpectomy for early-stage breast cancer?
Your first treatment decision is often about surgery. Before the 1970s, a mastectomy was the only surgery for for any stage of breast cancer. Since then, less invasive techniques have been developed, and imaging technology has greatly aided surgical accuracy. Patients have become more involved in treatment decisions and better informed of choices.

Still, deciding on a surgery for breast cancer is often difficult. Your goal is to remove as much cancer as possible, and prevent a recurrence. Let’s look at your options and some statistics about lumpectomy and mastectomy for early-stage breast cancer.

Answer:

If you have early-stage breast cancer (DCIS or Stage I, IIA, IIB, or IIIA), you may have a choice between breast-conserving surgery (lumpectomy) and removing the breast (mastectomy).

Women and Early-Stage Breast Cancer

It's normal to worry about how long you will live after surgery and treatment, or the chances of recurrence. These are practical questions to consider. The National Cancer Institute says that early-stage breast cancer patients who choose lumpectomy and radiation will live as long as women who opt for a mastectomy -- whether or not they also choose to have reconstruction. Your odds for recurrence of early-stage breast cancer are around 10% (1 in 10) within 12 years of lumpectomy and radiation. If you have a mastectomy, your risk of recurrence is about 5% (1 in 20) on the same side within 12 years of surgery; that risk is the same regardless of reconstruction surgery. You may also consider having chemotherapy, targeted biological therapy and hormone therapy to increase your chances of long-term survival.

Male Breast Cancer (MBC)

For early-stage male breast cancer, a mastectomy is recommended, because there usually is not enough breast tissue for a lumpectomy. Lymph nodes will be sampled to determine whether or not the cancer has spread beyond the breast. Radiation, chemotherapy and hormonal therapy may also be needed, depending on the type, extent and location of the cancer.

Considering Your Surgery Choices

Get help for making your breast cancer surgery decision by talking to your oncologist and surgeon. Try this list of 10 questions to help you sort out your feelings and options. If you have early-stage breast cancer and are not offered at least two options, go to a different doctor and get a second opinion. Ask about survival statistics based on your diagnosis, and about your surgeon's expertise in breast cancer surgery procedures. Sometimes your health insurance may limit your choices, but if you want more options, ask how you can work out a financial compromise. If you're favoring a mastectomy, you should also be discussing your choice of breast reconstruction methods. If breast reconstruction is not mentioned before you settle on a mastectomy, consult a plastic surgeon to see what your options may be. Make sure you feel as confident as possible when you choose your breast cancer surgery procedure.

Sources:

Choosing between lumpectomy and mastectomy. Surgery for Breast Cancer. Detailed Guide: Breast Cancer. American Cancer Society. Last Revised: 05/13/2009.

Surgery Choices for Women with Early-Stage Breast Cancer. National Cancer Institute. Posted: 10/22/2004.

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