If Cancer Comes Back After Lumpectomy, Mastectomy May be Best Choice

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For many women, lumpectomy followed by radiation therapy is a good alternative to mastectomy as the first treatment for early-stage breast cancer. A study wanted to see if one surgery option was better than the other if breast cancer comes back in the same breast (ipsilateral recurrence).

The results showed that women who had lumpectomy after breast cancer came back in the same breast had lower survival rates in the 10 years after the second surgery compared to women who had mastectomy.

About 750 women who had breast cancer come back in the same breast participated in the study. All the women had lumpectomy followed by radiation therapy to treat the first cancer. Many of the women also got chemotherapy and hormonal therapy to treat the first cancer.

Most of these women (76%) decided to have mastectomy to treat the second cancer, but 24% of the women decided to have another lumpectomy.

  • 5 years after the second surgery, 78% of the women who had mastectomy were alive compared to 67% of the women who had lumpectomy
  • 10 years after the second surgery, 62% of the women who had mastectomy were alive compared to 57% of the women who had lumpectomy

The research revealed a troubling finding: only 21% of the women who had lumpectomy after the cancer came back got radiation therapy after the second surgery. Lumpectomy is thought to be as good as mastectomy to treat an initial breast cancer only when followed by radiation therapy.

It may be that this lack of radiation therapy after a second lumpectomy partially explains the difference in survival rates. Radiation therapy is not always used after mastectomy. Only 5% of the women who got mastectomy after the breast cancer came back had radiation therapy after surgery.

If breast cancer comes back in the same breast after you've had lumpectomy, ask your doctor about the results of this study. Depending on your unique situation, mastectomy may be a better choice than lumpectomy. If you and your doctor decide that lumpectomy is the best choice for you, ask your doctor if you'll have radiation therapy after the second surgery, as well as how radiation therapy might improve your prognosis. Together, you and your doctor can make the best treatment choices for YOU.

You can learn much more about lumpectomy and mastectomy and reconstruction options in the Breastcancer.org Surgery section.

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