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Home > Research & Grants > Research and Scientific Programs > Lumpectomy versus mastectomy for early invasive breast cancer (February 2011)

  


Lumpectomy versus mastectomy for early invasive breast cancer (February 2011)

For women with a choice in early breast cancer treatment, lumpectomy plus radiation therapy (lumpectomy + RT) is considered as effective as mastectomy.  In making an informed decision on whether to have lumpectomy + RT or mastectomy, it’s important to explore the issues related to each treatment option. 

What are the differences between lumpectomy and mastectomy?

Type of surgery

Lumpectomy is the surgical removal of the tumor and some of the normal tissue surrounding it (not the entire breast). This surgery removes less tissue than mastectomy and can leave the breast looking as close as possible to the way it did before surgery. Most often, the shape of the breast and the nipple area are preserved.   

After a lumpectomy, a pathologist checks the tumor margins (the normal tissue surrounding the tumor) to make sure all the cancer has been removed.  When the margins contain no cancer cells (negative margins), the lumpectomy is successful.  However, if the margins contain cancer cells, more surgery must be done.  In these cases, a lumpectomy may no longer be an option and a mastectomy may be needed. 

Mastectomy is the surgical removal of the entire breast.  In a total (simple) mastectomy, the surgeon removes the breast, but no other tissue or lymph nodes. In a modified radical mastectomy, the surgeon removes the breast, the lining of the chest muscles and some of the lymph nodes in the armpit.  Breast reconstruction may be done at the same time as the mastectomy or at a later date.   

Radiation therapy (RT)

Radiation therapy to the breast is standard after a lumpectomy. It gets rid of any cancer cells that may remain after surgery.  This lowers the chances of the cancer returning.   

In contrast, most women do not need radiation therapy after a mastectomy.  

Chemotherapy and hormone therapy

Having lumpectomy + RT or mastectomy does not affect whether or not a woman’s treatment will also include chemotherapy or hormone therapy.  These choices are related to the characteristics of the tumor rather than the type of surgery. 

Risk of lymphedema

Lymphedema is a condition where lymph fluid collects in the arm, hand, finger or chest causing swelling.  The risk of lymphedema is the same whether a woman chooses lumpectomy + RT or mastectomy.  Women who have a large number of lymph nodes in the armpit removed during either type of breast surgery or who have radiation to these lymph nodes are more likely to develop lymphedema.1   

When is lumpectomy + RT an option?

Not all women are candidates for lumpectomy + RT.  In some cases, the location or size of the tumor make mastectomy a better option than lumpectomy.  These include:2 

  • Two or more tumors in different areas of the breast (multi-centric tumors)  
  • A large tumor, relative to breast size (for some women neoadjuvant therapy may reduce the size of the tumor enough so that lumpectomy is possible) 
  • A tumor spread throughout the breast (diffuse tumor) 
  • Attempts at lumpectomy cannot get negative margins   
  • Inflammatory breast cancer 

Women treated with lumpectomy must have radiation therapy.  Therefore, those who cannot have radiation therapy due to certain health conditions may need to have a mastectomy instead. These conditions include:2 

  • Scleroderma or systemic lupus 
  • Past radiation therapy to the same breast 
  • Pregnancy (radiation therapy is not given during pregnancy, but women can have a lumpectomy during pregnancy and have radiation therapy after delivery) 

Lumpectomy + RT versus mastectomy in treating early breast cancer

Overall survival

Findings from randomized controlled trials, meta-analyses and pooled analyses show there is no difference in overall survival between women with early breast cancer treated with lumpectomy + RT and those treated with mastectomy.3-9 Details of these studies are presented in Table 37 in the research section. 

Local and distant recurrence

The chance of the cancer returning in the breast (called local recurrence) is slightly higher with lumpectomy + RT than mastectomy.4,6,8,9 However, the risk of cancer spreading to other organs (called distant recurrence or metastasis and the main cause of breast cancer death), is the same for lumpectomy + RT and mastectomy.3,4,6   

Summary of risks and benefits: lumpectomy + RT versus mastectomy

There are risks and benefits to consider when choosing between lumpectomy + RT and mastectomy.  

The main benefit of lumpectomy + RT is that the breast is preserved as much as possible.   

The main benefit of mastectomy is that radiation therapy may not be needed. This can be an important factor for women who live far from a radiation treatment center.  And, although lumpectomy + RT and mastectomy are equally effective in treating early breast cancer, for some women, mastectomy offers more peace of mind. 

  

  

Mastectomy 

Lumpectomy + RT 

Amount of tissue removed 

Entire breast 

Part of breast (preserves the look of the breast as much as possible) 

Extent of surgery 

Major surgery with general anesthesia 

Less extensive surgery with general anesthesia  

Hospital stay 

Overnight hospital stay may be needed 

Longer recovery time than with lumpectomy + RT 

Often go home on same day as surgery  

Radiation therapy 

Sometimes done 

Routinely done 

Chance of local recurrence  

Low  

Low (but slightly higher than with mastectomy) 

 

According to Dr. Terry Mamounas, Professor of Surgery, Northeastern Ohio Universities College of Medicine and Medical Director, Aultman Cancer Center, Canton, OH, “Currently most women with early-stage breast cancer are candidates for lumpectomy and radiation therapy. This approach preserves the breast and provides the same overall survival to that achieved with total mastectomy. Advances in imaging and surgical techniques, radiation therapy and adjuvant systemic therapy have resulted in significant reduction in the rates of local recurrence after lumpectomy, making this procedure the preferred method of surgical management for the majority of patients with early-stage breast cancer.”        

Making treatment decisions that are right for you

Talk openly with your health care provider about your breast surgery.  You should feel confident that you are getting the best treatment possible.  If you are not satisfied with the rationale for your breast surgery, seek a second opinion.  Never hesitate to seek a second opinion from surgeons at different hospitals or practices.  

Remember that your choice of breast surgery will not affect your chances of survival.  And, while many women choose lumpectomy + RT, some prefer mastectomy.10-12 If presented with a choice in your breast cancer surgery, weigh the pros and cons of each and talk to your health care providers. Together you can choose which treatment is right for you.   


 

References 

1. McLaughlin SA, Cohen S, Van Zee KJ. Chapter 45: Lymphedema, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition. Lippincott Williams and Wilkins, 2010. 

2. Kaufmann M, Morrow M, von Minckwitz G, Harris JR; Biedenkopf Expert Panel Members. Locoregional treatment of primary breast cancer: consensus recommendations from an International Expert Panel. Cancer. 116(5):1184-91, 2010. 

3. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 347(16):1233-41, 2002. 

4. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 92(14):1143-50, 2000. 

5. Blichert-Toft M, Nielsen M, Düring M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol. Acta Oncol. 47(4):672-81, 2008. 

6. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 347(16):1227-32, 2002. 

7. Early Breast Cancer Trialists' Collaborative Group. Effects of Radiotherapy and Surgery in Early Breast Cancer. An Overview of the Randomized Trials. N Engl J Med. 333:1444-55, 1995. 

8. Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: A pooled analysis of updated results. Am J Clin Oncol. 28(3):289-94, 2005. 

9. van der Hage JA, Putter H, Bonnema J, et al. on behalf of the EORTC Breast Cancer Group. Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer. 39(15):2192-9, 2003.  

10. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 302(14):1551-6, 2009. 

11. Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 28(21):3437-41, 2010. 

12. Alderman AK, Bynum J, Sutherland J, Birkmeyer N, Collins ED, Birkmeyer J. Surgical treatment of breast cancer among the elderly in the United States. Cancer. 2010 Sep 30. [Epub ahead of print].