Many studies done in the 1970s showed that lumpectomy plus radiation to treat women diagnosed with stage I or stage II breast cancer offered the same survival rates as mastectomy. Based on these studies, the U.S. National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation was preferred over mastectomy to treat early-stage breast cancer.
Right now about 60% of women diagnosed with early-stage breast cancer choose lumpectomy followed by radiation.
Because the studies were done 40 years ago, researchers wondered if survival rates for lumpectomy plus radiation and mastectomy were still similar and decided to do a new study.
The results suggest that women diagnosed with early-stage breast cancer who have lumpectomy followed by radiation have slightly better survival rates than women who have mastectomy alone or mastectomy followed by radiation.
While the results seem perplexing, the design of the study may have had something to do with the outcome.
The research was published online on Jan. 15, 2014 by JAMA Surgery. Read the abstract of “Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer.”
In the study, the researchers looked at the medical records of more than 132,000 women diagnosed with stage I or stage II breast cancer between 1998 and 2008 who were treated with either:
- lumpectomy plus radiation (70% of the women)
- mastectomy alone (27% of the women)
- mastectomy plus radiation (3% of the women)
The researchers compared disease-specific survival rates between the three groups of women. Disease-specific survival is how long the women lived before they died from breast cancer.
Five years after diagnosis, disease-specific survival rates were:
- 97% for women who got lumpectomy plus radiation
- 94% for women who got mastectomy alone
- 90% for women who got mastectomy plus radiation
Ten years after diagnosis, disease-specific survival rates were:
- 94% for women who got lumpectomy plus radiation
- 90% for women who got mastectomy alone
- 83% for women who got mastectomy plus radiation
It’s not clear why women who had lumpectomy plus radiation had better survival rates than women who had mastectomy.
This study was a population-based study, which means the researchers used information that was collected before the study was planned. It also means that the women weren’t randomly assigned to get lumpectomy plus radiation, mastectomy alone, or mastectomy plus radiation. So the women who got mastectomy alone or mastectomy plus radiation may have had other health problems that may have affected the type of surgery they had. These other health conditions also may have affected their survival. Population-based studies aren’t considered as good as randomized clinical studies.
This study also didn’t look at:
- the type of health insurance the women had (if any)
- the distance to the nearest radiation treatment center
- how many reconstruction surgeons were available to each woman
- HER2 status of the cancer
- whether the women had earlier radiation to the chest wall
- the aggressiveness of the cancer
- other health conditions (diabetes, circulatory problems, or a bleeding disorder, for example)
All of which are known to affect the lumpectomy vs. mastectomy decision-making process.
If you’ve been diagnosed with early-stage breast cancer, you and your doctor will talk about a surgical approach that makes the most sense for you and your unique situation. You will take into account a number of factors, including:
- your preferences
- any other health problems you have
- ALL the characteristics of the cancer
- how close you are to treatment facilities
Whichever surgery you choose -- lumpectomy plus radiation or mastectomy with or without radiation -- know that much research has shown that both are equally effective in removing early-stage breast cancer and reducing the risk of it coming back.
For more information on factors to consider when deciding on a type of surgery for early-stage breast cancer, visit the Breastcancer.org Mastectomy vs. Lumpectomy page.
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