Lumpectomy
Breast-conserving surgery
Any form of surgery that removes only part of the breast is considered "breast-conserving" or "breast preservation" surgery. You may hear your surgeon use any one of several names: biopsy, lumpectomy, partial mastectomy, re-excision, quadrantectomy, wedge resection. Technically, a lumpectomy is a partial mastectomy, because part of the breast is removed. But how much of the breast is removed can vary greatly. Quadrantectomy, for example, means that a quarter of your breast will be removed. Be sure your surgeon discusses his or her "plan of action" with you, so that you have a clear understanding of how much of your breast may be gone after surgery.
Lumpectomy
Lumpectomy is the most common form of breast cancer surgery today. The surgeon removes only the part of your breast containing the tumor (the "lump") and some of the normal tissue that surrounds it. Read more about recommended treatments after lumpectomy. All the tissue removed from your breast is examined carefully to see if cancer cells are present in the margins—the normal tissue surrounding the tumor. Read an article about radiation after lumpectomy.
If cancer cells are found in the margins, extending out to the edge of the breast tissue that was removed, your surgeon will do additional surgery (called re-excision) to remove the remaining cancer. Most women receive five to seven weeks of radiation therapy after lumpectomy, in order to eliminate any cancer cells that may be present in the remaining breast tissue.
The combination of lumpectomy and radiation is commonly called breast-conserving therapy.
Is lumpectomy "good" breast cancer treatment?
A general principle of cancer treatment is that almost always, the "whole" breast must be treated for breast cancer. This can be accomplished by one of these options:
- mastectomy (removal of the whole breast)
- lumpectomy AND radiation therapy to the rest of the breast
A great deal of research has been done in recent years to determine if lumpectomy is as "good" an option as mastectomy for treating breast cancer. The evidence shows that lumpectomy followed by radiation IS likely to be equally as effective as mastectomy for women with:
- only one site of cancer in their breast
- a tumor under four centimeters, removed with clear margins (no cancer cells in the tissue surrounding the tumor)
Recent research continues to support this conclusion. The new research also confirms these results for younger, pre-menopausal women (under 50 years old). Other research confirms that even women with very small breast cancers (one centimeter or less) benefit from lumpectomy followed by radiation.
Doctors in some parts of the United States may be more old-fashioned and less likely to offer lumpectomy with radiation as an option for their patients, particularly their older patients. Such doctors may urge mastectomy, even for women who should be offered the choice. But recent research has shown that women 75 or older who get radiation after lumpectomy are more likely to live longer and remain free of breast cancer longer than women who do not get radiation. This research emphasizes the importance of offering the same treatment options to ALL women affected by breast cancer, regardless of age. Don't let hidden biases or unchanging attitudes keep you from getting the best care. Find a surgeon who keeps current, and whose techniques aren't limited to what used to be the standard of care twenty or thirty years ago.
Is lumpectomy and radiation right for you?
While lumpectomy and radiation is an excellent option for many women with breast cancer, it's not the best treatment for everyone. You may have to rule out lumpectomy if:
- you have already had radiation to the same breast for an earlier breast cancer
- you have extensive cancer in the breast or have two or more separate areas of cancer in the same breast
- you have a small breast and a large tumor, so that removing the tumor would be extremely disfiguring
- multiple attempts to remove the tumor have not been able to completely remove the cancer and obtain "clear margins"
- you have a connective tissue disease, such as lupus or vasculitis, that would make you sensitive to the side effects of radiation
- you are pregnant and so should not have radiation therapy
- you are not willing to commit to the daily schedule of radiation therapy, or distance makes it impossible
- you believe you would have greater peace of mind with a mastectomy