Breast Cancer Early Stage : Part 2

by Women's Health Information Center

(Page 2 of 4)

Fear is another reason why some women choose mastectomy. Some women are afraid of radiation therapy. Radiation therapy does cause side effects, but they are usually mild-like fatigue or skin irritation. Only very infrequently does radiation therapy induce more severe side effects.

Fear of recurrence of breast cancer is another reason why some women prefer a mastectomy to a lumpectomy. Some women assume that breast cancer won't return if the breast is removed. However, women may have a recurrence on the chest wall where the breast was removed because some breast tissue remains even following a mastectomy. For women who choose breast-conserving surgery with radiation, research clearly shows that radiation reduces recurrence for most women with early-stage breast cancer. The risk of cancer returning in the same breast is very low. After 12 years, only one out of approximately 10 women will have had a recurrence of cancer in the same breast. Most importantly, even if breast cancer does recur in the same breast, that does not reduce the woman's chances for a healthy recovery. However, a recurrence could require additional surgery, and a woman may decide to have a mastectomy at that time.

Many women want to make the surgical choice that will enable them to "get it over with and get on with my life." Many of these women choose mastectomies, in order to avoid the several weeks of radiation that is required for lumpectomy patients. However, even mastectomy patients may find that recovery takes longer than expected. Lymph nodes are removed with both lumpectomy and mastectomy, and the pain from arm swelling that can result may last a long time and be debilitating. If chosen, breast reconstruction after mastectomy often requires multiple additional surgeries and significant recovery time. Breast implant manufacturers have informed the FDA that one in four patients whose breasts were reconstructed with implants have at least one additional surgery within three years. For women undergoing TRAM flaps and other reconstruction procedures, the pain from surgery can last for months.

You say that the survival rate does not differ "significantly" between lumpectomy with radiation and mastectomy. But, if there is a tiny percentage difference in outcome, how many women does that represent? Isn't it significant to those women?

"Statistically insignificant" means that any difference could have occurred by chance, and not necessarily because one treatment is better than another. It does not mean the difference is small-it means it is not known whether the difference (however large or small) is related to the treatment or if it occurred by chance. It is necessary to conduct studies of thousands of breast cancer patients to determine whether small differences are "real" or occurred by chance. The studies that have been conducted seem to indicate that survival rates really are the same for women with early-stage breast cancer, regardless of the type of surgery.

Does the decision about what kind of surgery to have affect whether I need chemotherapy?

Chemotherapy is not recommended for most women with early stage breast cancer. If chemotherapy is recommended, it can improve survival and decrease the risk of breast cancer recurrence. There are several different kinds of chemotherapy, and it is sometimes used in combination with tamoxifen. Chemotherapy is usually given after surgery, but there are exceptions. For example, a woman with Stage III breast cancer may undergo chemotherapy before surgery to shrink a tumor so that she can undergo breast-conserving surgery.

I have breast cancer in my family. Should I choose the more aggressive treatment? Should I undergo surgery to prevent breast cancer?

Most women who have breast cancer in their families will never get breast cancer themselves-even if a mother or sister has died of breast cancer. In fact, even a woman with the mutated gene for breast cancer may never get breast cancer, even though her risk is much greater than other women with "breast cancer in their families" who don't have the mutated gene.

A family history of breast cancer increases your risk of breast cancer, but it is not necessary to choose more aggressive treatment or more radical surgery just because you have a family member with breast cancer. Research shows that a strong family history of breast cancer does not affect local recurrence rates or overall survival among women who undergo breast-conserving surgery. So family history should not influence your choice of either mastectomy or breast-conserving surgery.

Women diagnosed with breast cancer who have a family history of breast cancer are at increased risk of getting breast cancer in their healthy breast. Sometimes these women decide to have the other removed to prevent cancer in the future. Occasionally, women with several close relatives with breast cancer decide to have both their breasts removed as a preventive measure, even if they have never been diagnosed with breast cancer. Removing one or two healthy breasts reduces the risk of future breast cancer, but it does not eliminate the risk completely. The disadvantage is that the surgery will be unnecessary for most women who choose it, because most women who have a breast removed as a preventive measure would never have gotten breast cancer even if the breast (or breasts) were not removed.

Instead of surgery, there are other strategies that can prevent breast cancer, and it is advisable to obtain a second professional opinion before deciding to undergo a mastectomy to prevent, rather than treat, breast cancer.

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