Partial mastectomy better for survival than mastectomy?
A new study from the Netherlands has shown that a smaller surgery that removes only part of the breast, plus radiation, is just as effective as a mastectomy, and may even improve survival rates.
Breast conserving surgery (BCS), also called a partial mastectomy or lumpectomy, is a procedure where the tumour and the surrounding breast tissue is removed, but the majority of the breast is conserved. After breast conserving surgery, patients also need radiotherapy.
A mastectomy is a more extensive procedure where the whole breast is removed. After a mastectomy, radiotherapy isn’t usually necessary.
Not all women are eligible for both surgeries. If your tumour is large relative to your breast, or if the cancer cells are spread around your breast, you might need a mastectomy. But women with small, confined cancers usually have a choice between mastectomy and BCS.
The researchers followed over 37,000 women with breast cancer for 10 years to see whether the type of surgery had an effect on survival or cancer recurrence.
They found that women who had BCS and radiotherapy had a better survival rate than those who had a mastectomy. When looking at the chance of cancer recurring, the two procedures came in equal.
This large study adds to the growing body of evidence supporting BCS.
BCS offers huge benefits to patients. The surgery is smaller, so women only need to go into hospital for the day in most cases, whereas mastectomies usually involve a hospital stay. The recovery time for BCS is typically much shorter than for a mastectomy, and women can go back to driving and working much earlier. As well as that, a mastectomy involves separating the breast tissue from the chest muscles lying behind the breast. Some of the muscle may be removed or damaged during the surgery, intensifying the need for physical rehab after the surgery.
Large, high-quality studies have supported BCS as a treatment for early breast cancer, but many doctors and patients in New Zealand are still choosing mastectomies.
In Auckland between 2000 and 2012, around 50% of women who were being treated for breast cancer had a mastectomy, while just over 45% had BCS. The remaining 5% weren’t eligible for any kind of surgery.
There’s a belief, dubbed the “mastectomy myth”, that BCS isn’t as effective as mastectomy because the procedure removes less breast tissue, so there’s a higher chance that cancer cells will be left behind. This most recent study, and others before it, have shown that this is not the case.
In light of all this evidence, both doctors and patients can be confident in recommending and choosing breast conserving surgery. Women can save themselves pain and recovery time, while giving themselves at a chance at recovery that is at least as good, if not better, than with a mastectomy.
The NZBCF recommends all women have an in-depth discussion with their surgeons about which surgery best suits their situation. Here are some points worth considering:
The surgeries
BCS is an “easier” surgery to recover from. Usually you won’t have to stay overnight in hospital, and you’ll be able to resume driving and light activity after 1-2 weeks, instead of the 3-4 after a mastectomy.
How your breasts will look
The aim of BCS is leave your breasts looking relatively normal. Some surgeons offer to reduce the other breast so that the two are as even as possible.
A mastectomy is the removal of a whole breast, so some women choose to have the breast reconstructed, and that can sometimes be done at the same time. Other women choose to either have a reconstruction later, use a prosthetic, or not to have any kind of reconstruction. Some women even choose to remove both breasts, and although that doesn’t really have a medical benefit, it could allow for a more even reconstruction.
Radiotherapy
After BCS, women are required to have radiotherapy in their local hospital, which usually means 3-5 weeks of daily hospital visits. For women living rurally who are a long drive from their local hospital, a mastectomy might be the preferred option.
Your genetic risk
Women with a genetic mutation that increases their breast cancer risk, like BRCA1 or BRCA2, often choose to have both breasts are removed. This drastically reduces their chance of getting breast cancer.
If you want to discuss your surgery, or any other part of your treatment, call Sarah, our friendly breast nurse, on 0800 BC NURSE.