Lumpectomy, also called breast-conserving surgery, plus radiation therapy offers better survival rates than mastectomy — with or without radiation — for women who are diagnosed with early-stage breast cancer, according to a Swedish study.
The research was published online on May 5, 2021, by the journal JAMA Surgery. Read the abstract of “Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status: A Swedish National 6-Year Follow-up of 48,986 Women.”
Surgery options for early-stage breast cancer
Women who are diagnosed with early-stage breast cancer have two main surgery options:
- mastectomy, which is total removal of the breast
- lumpectomy, which removes the cancer, plus a healthy rim of tissue around the cancer, usually followed by radiation therapy
Radiation isn’t always given after mastectomy, but may be if the cancer is large or considered to have a higher risk of recurrence (the cancer coming back).
Many studies done in the 1970s showed that lumpectomy plus radiation to treat women who are 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.
When making decisions about surgery for early-stage breast cancer, you and your doctor will take into account a number of factors besides the characteristics of the cancer, including:
- the size of the cancer compared with the size of your breast; if lumpectomy would remove a major portion of the breast, then mastectomy may be a better option
- the location of the tumor
- whether you are able to make it to all your radiation therapy appointments after surgery
- any other health conditions you might have
- your age
- your personal preferences
Questions about research that studies survival after each type of surgery
A number of experts questioned recent studies that have suggested lumpectomy plus radiation offers better survival rates than mastectomy without radiation for early-stage breast cancer.
These experts wondered if the women in the studies who had lumpectomy plus radiation had smaller tumors or cancers that had not spread to the lymph nodes compared with women who had mastectomy. If this were true, the women who had lumpectomy plus radiation would be expected to have better outcomes because the cancers they were diagnosed with would be considered less aggressive.
The experts considered that mastectomy may be recommended for women who live in remote areas and would have to travel several hours to a facility to receive radiation therapy.
The experts also pointed out that mastectomy is more common in women with lower incomes. Having a lower income also is linked to other factors associated with worse breast cancer outcomes, including:
- having other health issues
- being diagnosed with breast cancer at a more advanced stage
- being less likely to have chemotherapy after surgery
So, the experts wanted to do a study that took into account all these factors that may affect survival rates and provide a clearer analysis of lumpectomy plus radiation compared with mastectomy outcomes.
About the study
The study included 48,986 Swedish women who were diagnosed with early-stage breast cancer and had breast cancer surgery between 2008 and 2017:
- 59.9% had lumpectomy plus radiation
- 25.3% had mastectomy alone
- 14.7% had mastectomy plus radiation
Researchers followed about half the women for less than 6 years and half for longer periods of time.
The researchers noted the following differences between the groups of women:
- Women who had lumpectomy plus radiation had smaller tumors with less lymph node involvement (the presence of cancer cells in lymph nodes) than women who had mastectomy plus radiation.
- Women who had mastectomy alone were the oldest, on average, and had about the same rates of lymph node involvement as women who had lumpectomy plus radiation.
- Women who had mastectomy plus radiation were more likely to have treatment before and after surgery, including chemotherapy and targeted therapy medicines.
- Women who had mastectomy alone had less education and lower income levels than women in the two other surgery groups.
- Women who had mastectomy, with or without radiation, were more likely to have other health conditions than women who had lumpectomy plus radiation.
Overall, 6,573 women died during follow-up; 2,313 (35.2%) of these deaths were because of breast cancer.
Five-year overall survival rates by surgery group were:
- 95.1% for women who had lumpectomy plus radiation
- 86.0% for women who had mastectomy plus radiation
- 84.5% for women who had mastectomy alone
The 5-year overall survival rate is the percentage of women who were alive 5 years after diagnosis, whether or not the breast cancer came back.
Five-year breast cancer–specific survival rates by surgery group were:
- 98.2% for women who had lumpectomy plus radiation
- 90.5% for women who had mastectomy plus radiation
- 95.0% for women who had mastectomy alone
The 5-year breast cancer–specific survival rate is the percentage of women who did not die from breast cancer 5 years after diagnosis.
Ten-year overall survival rates by surgery group were:
- 87.3% for women who had lumpectomy plus radiation
- 72.1% for women who had mastectomy plus radiation
- 67.0% for women who had mastectomy alone
Ten-year breast cancer–specific survival rates by surgery group were:
- 96.1% for women who had lumpectomy plus radiation
- 84.6% for women who had mastectomy plus radiation
- 91.0% for women who had mastectomy alone
Even after the researchers took into account all the other factors that could affect survival, lumpectomy plus radiation still offered better survival rates than mastectomy plus radiation and mastectomy alone.
“This report adds evidence to support the recommended use of [breast-conserving surgery] with [radiation therapy] in both node-negative and node-positive breast cancer,” the researchers concluded. “Neither socioeconomic background and comorbidity nor the addition of postoperative [radiation therapy] after mastectomy diminished survival differences.”
What this means for you
If you’ve been diagnosed with early-stage breast cancer, you and your doctors will talk about a surgical approach that makes the most sense for you and your unique situation. You may consider a number of factors, including:
- the characteristics of the breast cancer
- your age
- any other health conditions you might have
- your preferences
- how close you are to treatment facilities
- your personal risk of recurrence and your concern about the cancer coming back
- your reconstruction options and preferences
At Breastcancer.org, we support everyone’s right to make treatment decisions based on the characteristics of the cancer they’ve been diagnosed with, their medical history, their risk of recurrence or a new breast cancer, and their personal preferences. But it’s very important to make sure you understand all the pros and cons of any treatment or procedure you’re considering, including differences in survival rates.
Read more about Mastectomy vs. Lumpectomy.
To discuss the risks and benefits of lumpectomy or mastectomy with others, join the Breastcancer.org Discussion Board forum Surgery - Before, During, and After.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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