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Smaller Surgery May Extend Life

Posted 1/31/2013

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This is important. A new study from the UK looked at more than 112,000 women who had breast cancer. They were treated by either mastectomy or lumpectomy, and the surprising result was that those who had the smaller surgery lived longer. This feels particularly important given the current rise in the numbers of women who are choosing mastectomies, often double mastectomies. The best understanding of this trend is that women make this decision based at least as much on fear as on facts. We all remember the early days after diagnosis, and our panicked wish to do anything, anything, anything to stay well and to prevent having to go through this again.

I have written a number of times about this issue. I absolutely believe that women are entitled to make their own decisions, and that we tend to make the right choices for ourselves. But I also know that a mastectomy, with or without reconstruction, is a very big deal, and that it is nicer to have one's natural breasts than not. You may know that my first breast cancer in 1993 was treated with lumpectomy and radiation; the second in 2005, because it was in the same breast, required a mastectomy. I knew that would be necessary, and I have never regretted the choices I made that spring, but I surely miss my breast. I am giving you this background to buff up my credibility on this issue. That is, I have done it both ways.

This study is surprising as the standard refrain has been that, in most cases, prognosis the same for either surgical choice. The worry generally is that a lumpectomy will turn out to be less good, not that it will be more helpful. I suspect that there are many ways to look further at this data, and that will happen. The most obvious concern is that women who had mastectomies may have needed them because they had later stage/larger tumors. If this is valid, that could explain their less good survival--that it was really about the cancer itself, not about the surgical choice.

At any rate, here is a summary from Web MD. I give you the beginning and then a link to read more:

Does having a mastectomy affect how long you live after breast cancer treatment?

A new study has found that women who choose to have treatment for breast cancer but keep their breast are more likely to live for longer, and live for longer without their cancer coming back, than women who have their breast removed.

By Lilian Anekwe

Breast cancer is the most common cancer in women. It accounts for around 33 in every 100 cancers diagnosed in women. About 48,000 women are diagnosed with breast cancer in the UK each year.

Women with breast cancer face a number of decisions about their treatment. The treatment options available depend on a number of things, including what ‘stage’ cancer you have.

The stage of a breast cancer means the size of the tumour, and where it grows in the breast or in the body. For example stage 1 or 2 breast cancers are generally smaller and almost always grow inside the breast, or sometimes under the armpits. These are generally called early­stage breast cancers.

Treatments for early­stage breast cancer include an operation to remove the entire breast that has cancer. This is called a mastectomy. Another treatment is breast­conserving surgery. This means an operation to remove only the part of the breast that has the cancer, plus a small amount of healthy tissue around the cancer. This is sometimes called a lumpectomy.

In studies, women who had mastectomies haven’t lived for very much longer than women who had breast­conserving surgery. But we’re still not sure if the same can be said of women in the real world. The studies that have looked at this have lasted only a few years, whereas we would need longer studies to assess the difference between the treatments.

This study looked at 112,154 women who had either mastectomies or breast­conserving surgery for stage 1 or 2 breast cancer between 1990 and 2004. The researchers monitored the women for an average of nine years. They compared how long the two groups of women lived, and, if their cancer came back, how much time passed before it came back.

What does the new study say?

Overall 31,416 women died during the study. In 39 in every 100 women who died, the cause was breast cancer.
When the researchers compared the two groups, they found that women who had breast­conserving surgery were more likely to live for longer than women who had a mastectomy. They were also more likely to live for longer without their breast cancer coming back than women who had a mastectomy.

The biggest benefit was in women who were older than 50 and who had a type of breast cancer called hormone­receptor positive breast cancer.

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