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April 24, 2023

Medical advancements are giving breast cancer patients more surgical options

Mastectomies are the standard of care in many cases. But new research shows some women with multiple tumors in one breast may benefit from lumpectomies, which preserve existing tissue

Women's Health Breast Cancer
Breast cancer surgery Angiola Harry/Unsplash

Mayo Clinic researchers found that some women with two or three tumors in one breast still can have a low rate of cancer recurrence even without needing a mastectomy. They can instead undergo a lumpectomies.

Breast cancer death rates have been declining since 1989, but the disease remains the second leading cause of cancer death in women. And incidence rates have increased slightly in recent years. 

For people diagnosed with breast cancer, choosing the right treatment option can be daunting. Many women want to eradicate the cancer but also preserve as much breast tissue as possible.

Depending on the type and stage of cancer, breast preservation isn't always possible. But advancements in surgical technique have given many early-stage breast cancer patients the option to have just a lump of breast tissue removed, rather than the entire breast.   

Here are some of the benefits and risks of a lumpectomy vs. a mastectomy:

Mastectomy: The standard of care

A mastectomy, the removal of the entire breast, is the standard of care for most breast cancer patients. 

Mayo Clinic oncologists say the procedure usually is recommended when a person has two or more tumors in different areas of the breast, has malignant-appearing calcium deposits throughout the breast, has a recurrence of breast cancer after radiation therapy, carries a breast cancer gene mutation that increases the risk of developing a second cancer in the breast, or has a large tumor relative to the size of the breast. People who can't undergo radiation therapy also are advised to get mastectomies.

In the last decade, even women with cancer in the early stages have been choosing to have mastectomies in hopes that they will better protect them from recurrent cancer.

Dr. Lisa Jacobs, a Johns Hopkins surgical oncologist, says more women are choosing to have mastectomies because improved breast reconstruction techniques allow for a more natural breast appearance and federal law now requires reconstruction to be covered by insurers. 

As with any surgery, there are risks. After a mastectomy, a woman will have an increased risk of bleeding, infection, swelling, numbness, shoulder pain and stiffness.

People who also choose to have breast reconstruction may need to have multiple surgeries and will have a longer recovery process. 

Lumpectomy: Less reconstruction needed

A lumpectomy removes tumors while still preserving as much healthy breast tissue as possible. Breast-conserving therapy also includes radiation therapy to catch any lingering cancer cells.

In recent years, there have been many advancements in breast-preserving surgery. These include radar localization technology that better targets the tumor's location, hidden scar surgery in which incisions are made around the areola or in the crease of the breast, and oncoplastic surgery, in which the breast surgeon works with plastic surgeons to improve the appearance of the breast after cancer cells have been removed. As the procedure has become more precise, less reconstruction of the breast is needed.

The risks associated with lumpectomies include infection of the breast skin from incision, numbness, loss of sensation or nerve pain at the incision site, slightly uneven breasts and other physical changes to the breasts. These physical changes often can be addressed by a reconstructive plastic surgeon.

The procedure usually is recommended for women with early-stage breast cancer with small tumors. A mastectomy is still the standard of care for women who have multiple tumors in a breast, especially if they are in different quadrants, but that may change. A new study suggests that even women with multiple tumors in a breast can get good results with a lumpectomy.

Mayo Clinic researchers found that under certain conditions, women with two or three breast tumors in one breast can still have a low risk of cancer recurrence even if they choose not to have the breast removed. The 200-plus women included in the study had a five-year local recurrence rate just higher than 3%.

That rate was similar to that of women who had undergone a mastectomy, Dr. Judy Boughey, a breast surgical oncologist, told U.S. News & World Report. However, Boughey emphasized that a lumpectomy is not a one-size-fits-all procedure for women with multiple tumors. 

"Each tumor had to be less than 5-centimeters in size," Boughey said. "They need a breast size that allows resection of both lesions with enough remaining breast tissue to conserve," referring to tumor: breast size ratio.

Women under age 40 and those with a genetic predisposition for breast cancer were not included in the study. Women who underwent MRIs before treatment, in addition to mammograms and ultrasounds, had a lower recurrence rate. 

More research is needed to confirm the findings of the study, but data from Johns Hopkins Medicine shows a similar recurrence rate between a lumpectomy and a mastectomy. Their researchers have found the recurrence rate for both procedures is about 10% in the treated breast and about 0.5% per year in the breast that has not been treated. 

Besides surgery, other treatment options for treating breast cancer include chemotherapy, radiation, immunotherapy – which targets deficiencies in the immune system that promote cancer cell growth – and targeted therapy, which uses drugs to attack specific features of cancer cells, like certain enzymes, proteins or gene mutations. Immunotherapy and targeted therapy often are used in conjunction with radiation therapy, chemotherapy or surgery.

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