Lumpectomy or Mastectomy, How to Decide?
Read the stories of other women who have had to choose which surgery to have for their breast cancer treatment
Roughly 200,000 new cases of breast cancer are diagnosed in the U.S. each year, and many of those patients will think, ‘Lumpectomy or mastectomy, how do I decide?’
Early detection has implications for surgical options, since most of these women will have surgery as part of their treatment. This means the vast majority of newly diagnosed breast cancer patients are likely candidates for breast conserving surgery (BCS), the least invasive surgical option.
The History Behind Breast Cancer Surgery Decisions
Not so long ago, a mastectomy was the only surgery option – there was no reason to have to decide between lumpectomy or mastectomy. Mastectomies were first performed in the U.S. in the early 1900s. Until the 1970s, most women underwent radical mastectomies – a dramatic procedure that removes the breast tissue, nipple, and areola, as well as the underarm lymph nodes and chest wall muscles on the affected side.
The modified radical mastectomy, introduced in the 1960s, reduced the extent of the mastectomy to only the breast area and lymph nodes with minimal impact on the chest muscles. The modified radical mastectomy is the most common type of mastectomy performed today.
A lumpectomy procedure consists of removing only the lump and surrounding area, preserving the majority of the breast. In the 1980s, considerable advances in lumpectomies and other forms of BCS began being performed in the U.S., and their usage has increased steadily since then.
Lumpectomies typically require 5 to 7 weeks of radiation therapy following surgery. This can be a factor when wondering how to decide between lumpectomy and mastectomy.
Research has shown that the combination of lumpectomy plus radiation therapy has equal long-term survival rates as a mastectomy, which is reassuring.
How Do We Make the Lumpectomy or Mastectomy Choice?
Even with equal results, though, half of breast cancer patients who are eligible for a lumpectomy undergo a mastectomy instead. Why? How do they make that lumpectomy or mastectomy decision the way that they do?
Studies over the past 20 years have shown several key influencing factors, including:
- The physician encourages it. Older surgeons are particularly more likely to recommend a mastectomy because a lumpectomy is a more recent procedure, so they tend to choose an approach they know and are familiar with: for them it’s the best solution.
- Where a patient lives. There have always been regional differences in new treatments, in which the Southeast and Midwest states tend to lag behind the Northeast and Mid-Atlantic in new approaches to treating disease. Consequently, women contemplating how to decide on lumpectomy or mastectomy in the Southeast and Midwest more often choose mastectomy, because it’s performed more in those regions.
- The type of hospital. Non-university medical centers, along with some smaller, rural hospitals sometimes don’t have radiation therapy capabilities; therefore, mastectomies are more common since radiation therapy must be combined with a lumpectomy in order to be effective.
- The type of insurance coverage. Insurance sometimes dictates how you decide on lumpectomies vs. mastectomies. Lumpectomies can be more expensive than mastectomies because of the radiation therapy involved. Not all insurance plans cover the cost of a lumpectomy and the radiation therapy that follows. For those without insurance coverage, a mastectomy may be the only option.
- Socio-economic factors. Large health disparities exist among minority groups in lower income brackets and with lower education backgrounds. A host of socio-economic factors impact the degree to which a patient interfaces with their physician. For example, patients with less education and lower incomes are much less likely to question their physician or seek a second opinion. That may affect how they decide (or whether they have a choice at all).
- Older women (70 years and older) tend not to question their physicians compared to younger generations. Also, breast loss is often of more of a concern among younger women, so they may be more interested in choosing lumpectomy over mastectomy than older women.
- Psychological well-being. There are a number of women who feel safer having their breasts removed to assure there will be no recurrence of cancer.
Although these major drivers promote mastectomies, lumpectomies are increasingly the preferred option today. For the most part, women choose lumpectomies over mastectomies in order to preserve their natural breasts as long as they can. Ultimately it comes down to a woman’s personal choice. Such is the case with the following breast cancer survivors, who were eligible for either surgical options and chose one over the other.
‘Lumpectomy or Mastectomy, How to Decide?’: Kim
Kim, 48 years old, who is celebrating her 10th year of being cancer-free, is a third generation survivor. Her grandmother had a radical mastectomy in 1958, and mother underwent a modified radical mastectomy in 1978. Almost 20 years later, Kim opted for a lumpectomy. “Although I was okay with removing my breast if I had to, it was really cool waking up and having some of my breast left on my chest.”
‘Lumpectomy or Mastectomy, How to Decide?’: Libby
Libby also chose a lumpectomy. “We were assured that since I had such early stage breast cancer, a lumpectomy would be completely sufficient to get rid of all of the cancer. Ironically, I had to go back three days after my original lumpectomy to have more removed because my surgeon didn’t feel, based on the returned lab report, that she had gotten enough of a margin.
“I must say that was a bit traumatic for me and my husband, but we knew we were in good hands, so that made it a bit easier to handle. It was three years this past January since my diagnosis and treatment. I’m fortunate enough to say that I’ve had no further problems and remain cancer-free. And every day of life now is the greatest gift.”
‘Lumpectomy or Mastectomy, How to Decide?’: Kathy
Kathy still feels good with her lumpectomy decision. “After doing as much reading and research as I could, I talked with my doctor, with friends—some of whom had lumpectomies and others who had complete mastectomies—and also my contact at City of Hope, which is a cancer research hospital. In everything, I was able to discover with my kind of cancer and tumor, there was no research that indicated any significant benefit to have a mastectomy. I felt, and still do feel, very comfortable with my decision.”
‘Lumpectomy or Mastectomy, How to Decide?’: Lynn
Lynn, on the other hand, chose a mastectomy. “I was diagnosed with DCIS, non-invasive cancer. The lumpectomy would have removed 20-30% of the breast tissue because of the location near the middle and at the back near the breast plate.
Related article: The different types of breast cancer
There was no guarantee that future lumpectomies would not be required in other areas, as the entire breast showed clusters of calcification.
“I decided on a mastectomy in order to have reconstruction with minimal scarring. A series of lumpectomies would have made a future reconstruction difficult in my case. This turned out to be the best decision for me since DCIS was found in other areas and I would have lost this breast anyway.
“I have had excellent treatment and no problems with either surgery (mastectomy and reconstruction).”