Lumpectomy OK for Some Larger Breast Cancers in Older Women

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Lumpectomy (also called breast-conserving surgery) followed by radiation is considered equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor that is smaller than 5 centimeters in size.

Almost all doctors recommend mastectomy surgery for a tumor that is larger than 5 centimeters. Also, people diagnosed with breast cancers tumors that are larger than 5 centimeters have been excluded from clinical trials comparing lumpectomy to mastectomy, so not much information is available on how effective lumpectomy is for larger cancers.

A study has found that in older women diagnosed with breast cancers larger than 5 centimeters, lumpectomy offered the same overall survival and breast cancer-specific survival rates as mastectomy.

The study was published online on Oct. 19, 2015 by the journal Cancer. Read the abstract of “Breast conservation versus mastectomy for patients with T3 primary tumors (>5 cm) a review of 5685 medicare patients.”

This study was a retrospective study, which means the researchers analyzed information that was collected before the study was designed.

Overall survival is how long the women lived, whether or not the breast cancer came back. Breast cancer-specific survival is the number of women who didn’t die from breast cancer.

In the study, the researchers looked in the SEER database to find 5,685 women age 66 or older who had been diagnosed with breast cancer that was larger than 5 centimeters between 1992 and 2009. None of the breast cancers were inflammatory or metastatic. All the women had Medicare insurance. Follow-up was about 7 years.

Slightly more than 15% of the women had lumpectomy.

SEER databases are large registries of cancer cases from sources throughout the United States maintained by the National Institutes of Health.

Women were more likely to have lumpectomy if they:

  • had chemotherapy before surgery and radiation after surgery
  • were in a higher income bracket
  • had a number of other health problems
  • were being treated for cancer for the first time

Women were more likely to have mastectomy if they:

  • were younger
  • had a higher-grade breast cancer
  • had stage III cancer
  • had several positive lymph nodes
  • had chemotherapy after surgery

Still, overall survival and breast-cancer specific survival were the same for women treated with lumpectomy and women treated with mastectomy.

The researchers found that while lumpectomy rates have been increasing in women with Medicare insurance since 1992, only one in five women with a tumor larger than 5 centimeters was offered lumpectomy as late as 2009. The researchers think this may be because there have been few studies looking at the safety of lumpectomy for tumors this large. Also, current treatment guidelines say that tumors larger than 5 centimeters should be treated with mastectomy instead of lumpectomy.

"Despite exclusion from randomized trials, [lumpectomy] may remain an option for patients with larger tumors when deemed clinically and cosmetically amenable to surgical resection," said the researchers. "The current study is consistent with the few smaller retrospective series that have suggested that a tumor size >5 cm should not remain a relative contraindication to [lumpectomy].”

The researchers also pointed out that lumpectomy plus radiation is now the treatment standard for women diagnosed with early-stage disease and that the results from their study reinforce the idea that the option of lumpectomy should be offered to all women who are good candidates.

"We recommend that tumor size no longer be considered a relative contraindication in this subgroup of patients when breast size can accommodate such a resection," they said.

If you’re an older women who has been diagnosed with breast cancer that is larger than 5 centimeters and are making decisions about surgery, the results of this study are encouraging.

While most women who have a choice prefer the less invasive lumpectomy, deciding between lumpectomy and mastectomy depends on a how you feel about the following:

  • Do you want to keep your breast? If it’s important to you to keep your breast, you may decide to have lumpectomy with radiation instead of mastectomy.
  • Do you want your breasts to match as much as possible in size? For most women, lumpectomy has a good cosmetic result. In rare cases when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted. There are types of reconstruction available for both lumpectomy (if there is significant distortion) and mastectomy. If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
  • How anxious will you be about breast cancer coming back? If removing the entire breast would help you worry less about the possibility of the breast cancer coming back (recurrence), you might consider mastectomy.

As you and your doctor make a decision about surgery, you will also consider other factors, such as your overall health and any other medical conditions you have, as well as your personal preferences. Together, you can make the best decision for you.

For more information on the advantages and disadvantages of both mastectomy and lumpectomy, visit the Breastcancer.org Mastectomy vs. Lumpectomy page.



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