For Younger Women, Lumpectomy May Be as Effective as Mastectomy

For decades, we have known that lumpectomy (also called wide local excision or partial mastectomy) is as effective as mastectomy for women over 50 with non-metastatic breast cancer. It has been harder to say the same thing for young women because the numbers are much smaller, and researchers often have to wait decades to observe results.

The real danger is not a local recurrence, but the possibility of the cancer spreading to another part of the body.

A recent study suggested that more than 60% of women younger than 40 with newly diagnosed breast cancer opt for mastectomy — often for bilateral mastectomies. It is easy to appreciate having distress about the diagnosis and wishing to rid one’s body of the offending organ(s), hoping never to have to go through this again.

However, most of the time, it is not considered medically necessary for a woman to have the larger surgery; but it is tough to convince a frightened young woman with a new diagnosis of this fact. It is also likely that many young women have been influenced by media reports of celebrities opting for bilateral mastectomies. The best-known example is Angelina Jolie, who chose prophylactic surgery in 2013 because she carries the BRCA1 mutation that greatly increases her chances of developing breast cancer. Some people may not realize that she had the surgery before being diagnosed with breast cancer, so the reasons are very different.

Presented at the recent meeting of the American Society of Breast Surgeons, the study above observed almost 600 women, all younger than 40, who had been treated between 2010 and 2018. The median follow up was 67 months. During that period, 12% of the women died. No matter the type of tumor (ER positivity, HER2 positivity, etc.), there was no association between the chosen type of surgery and the outcomes.

Regardless, there always are certain circumstances in which a surgeon will recommend a mastectomy over smaller surgery; examples include a large tumor in a small breast, a tumor that is diffusely scattered within the breast, or a woman who carries a gene mutation.

A new cancer diagnosis scares everyone. Younger adults, perhaps especially those with young children, may be even more frightened. It is completely understandable that the instinctive reaction often is to “get rid of them.” Indeed, a mastectomy will greatly reduce the chances of the cancer ever returning in the breast; however, since even that surgery does not remove 100% of breast tissue, there is still a small chance of a local recurrence.

What many women, at the time of diagnosis, do not appreciate is that the real danger is not a local recurrence, but the possibility of the cancer spreading to another part of the body. It is essential that doctors, now equipped with even more data, counsel their new young patients that keeping their breasts is usually just as safe.