According to the National Cancer Institute, breast cancer is the second most common type of cancer in American women. Women in the United States are diagnosed with breast cancer more than any other type of cancer with the exception of skin cancer.
However, the good news is that the number of new cases of breast cancer has decreased from 1999 to 2006, and deaths from breast cancer have decreased every year.
When a women is diagnosed with breast cancer, she may have to decide between a mastectomy and a breast conserving lumpectomy. This is a decision best made between a women and her doctor. What are some of the factors that go into making this very important decision?
Listen in as Lori Medeiros, MD explains the differences to these two types of treatments and how the Rochester General Breast Center is your partner on this very personal journey.
Selected Podcast
Mastectomy vs Lumpectomy: How Do You Decide Which One is Right for You?
Featured Speaker:
Learn more about Lori Medeiros, MD
Lori Medeiros, MD, CM
Lori Medeiros, MD, CM is the Medical Director at Rochester General Breast Center.Learn more about Lori Medeiros, MD
Transcription:
Mastectomy vs Lumpectomy: How Do You Decide Which One is Right for You?
Bill Klaproth (Host): If something suspicious was found during regular routine screening mammogram, how does a woman make that decision if she has a choice between lumpectomy and mastectomy? My guest today is Dr. Lori Medeiros. She is the Medical Director in the Rochester General Breast Center. Dr. Medeiros, thank you for your time. So, if something is found and a woman has a choice between lumpectomy or a mastectomy, how does a woman make that decision?
Dr. Lori Medeiros (Guest): Yes. That is a great question. So, women who are newly diagnosed in breast cancer often have a choice and it’s really important to talk about the fact that these two treatments are equivalent, meaning there is no survival difference whether you opt for lumpectomy or you opt for a mastectomy, as long as you’re able to make that decision. So, there are some women that come in who are newly diagnosed who, unfortunately, don’t have a choice and those are usually women who have many tumors that are in lots different places in the breast; women who’ve had previous treatment with radiation who may not be able to undergo lumpectomy again with radiation therapy; or people who had mantle radiation. So, these are women who’ve had things like Hodgkin’s Lymphoma in the past and that kind of thing. And, there are certain family syndromes or family histories that we worry about a little bit, for people who have a risk developing cancers from radiation. So, lumpectomy is a treatment that is given with radiation or hand-in-hand. Mastectomy often can avoid radiation but sometimes also requires it. So, it’s very individual, but the choice between the two really involves a pretty detailed discussion between the woman and her surgeon, as you can imagine.
Bill: Quickly give us the advantages and disadvantages of a lumpectomy; then quickly the advantages and disadvantages of a mastectomy, just so we break this down to the easiest possible way for somebody to understand the differences between the two.
Dr. Medeiros: Sure. I think the big thing for most women is the addition of radiation therapy. So, remember lumpectomy, or removing the part of the breast involves, later on, doing radiation therapy and that usually starts three to four weeks after surgery or after chemotherapy, as the case maybe. So, radiation therapy is something that’s very well tolerated by most women. It does not involve IV’s. It does not involve any medicines that go into your blood stream. Basically, what it is, is a focused beam that goes to the breast and controls the cancer from coming back. So, there is no hair loss, no nausea. There is no vomiting. There is nothing like that. The main side effects of radiation that women experienced are things like fatigue and changes in the skin. So, that can range from reddening of the skin to darkening of the skin in the general area where we do the radiation. Some women can get like a sunburn and that, generally, is self-resolving. So, most of this things are temporary and they’ll go away. The things that women worry about with radiation are extremely rare. So, what women talk a lot about which are, unfortunately, extremely rare occurrences with radiation, is damage to other organs. With modern radiation, it’s important to realize that when that radiation beam is being delivered, there is a whole team that is there to help deliver that and it’s done with pretty advanced scans that kind keep the beam off the heart, off the lung and that kind of thing. The big thing with radiation from a practical standpoint for most women is that can be time consuming So, we're pretty fortunate feels offers the cutting edge types of radiation that are delivered over very short periods of time. So, these are called “partial breast radiations” and they can be done in as short period of time as 5 days, but conventional radiation can range up to about 6 weeks. So, for a lumpectomy, being able to accept those risks of radiation is an important part of the conversation because that’s all one treatment--the lumpectomy with the radiation. The other thing with lumpectomy, on the flip side that’s the big positive for it, is that you preserve the breast. So, you preserve the nipple, you preserve sensation and you preserve function with that. For most women, it tends to be the less emotional to do the lumpectomy than the mastectomy because it’s not quite as big a change in body image. Even with reconstruction, mastectomy can be quite a change, as you can imagine, in a woman’s body image and in her psychology and a big part of recovery for breast cancer has to do with how you recover emotionally. Lumpectomy tends to be day surgery, which means that you would come in, have the surgery, and go home the same day. So, that can be a big advantage for a lot of women. On the flip side, of course, you do the radiation later on. There is some time commitment there. Anyway, from a cosmetic point of view, a well done lumpectomy generally winds up being better than a mastectomy because, of course, it’s the natural breast. So, you have the natural contour and the natural form. On the flip side with the mastectomy, the pros for that would women who feel like they don’t want to do radiation. Mastectomy can still, of course, require radiation later but it’s usually in situations where we dealing with high risk cancers; so, cancers that have already developed and gone into lymph nodes and things like that, or very large cancers. So, by and large, for the average woman who has a choice between the two, mastectomy may avoid radiation therapy and, for some women, that’s the big driving force. The other part for mastectomy for some woman is the time commitment for the radiation therapy. So, women who live a long distance from a radiation facility or who otherwise just can’t commit to that or can’t lie in that position may opt for mastectomy for that reason. It tends to be a pretty personal choice. What I usually tell patients is that there is no wrong answer here. There is not one that better than the other but it’s important to understand the pros and cons of both because you are making a decision that really is going to impact you, not only in the short term, but, more importantly, in the long term since most breast cancer does quite well, especially when caught in the very early stages. So, these considerations, while they seem maybe trivial in comparison to the breast cancer, so things like cosmetic outcome and body image and that kind of thing are certainly not at the top of woman’s list when she has just been diagnosed but, you know, they’re real considerations and they should be a close second. So, you know, thinking about this is important because it may influence how you would recover emotionally from this.
Bill: When a woman is facing this, do you just leave the decision completely up to them or do you offer guidance as well?
Dr. Medeiros: It depends on the situation because everything is case by case but, generally speaking, for a woman who really has a choice between the two, I generally go through these pros and cons, of course, with the nuances that are specific to each woman in terms of their family history and their lifestyle and that kind of thing. I think, you know, if somebody asks me, I’ll certainly tell them which way I would go, and, you know, my preference is frankly, for a woman who can have the choice between the two, I do find that the lumpectomy with radiation therapy tends to result in a return to normal, getting back to normal, a little bit quite quicker than the mastectomy for most women, but, you know, I’ve seen woman go both ways and they very happy with it. I think the real important piece of this is that, you know, cancer is a very frightening diagnosis. It takes a lot of control away from you. It’s certainly a period of time in your life when it’s in upheaval. So, making a decision that allows you to feel like you’ve really thought about this and you’ve made the decision from the point of view of real self-reflection and thinking what’s best for you is really in the long-term really important because, you know, having that death of control over it or at least partner in that health care decision, I think, overall really is important to overall outcomes.
Bill: And, Dr. Medeiros, can you wrap it up for us? Why should someone choose Rochester General Breast Center for their care?
Dr. Medeiros: I think for me, it’s really the quality of the team. We have really a wonderful group of people here who work, not only collaboratively within the system, but also with other organizations and other groups outside of the system. So, everybody is really focused on trying to get you from point A to point B with as little emotional trauma as you can, given what you’re dealing with. That’s the part I think really makes a difference because, of course, we use the most advanced treatment and, of course, everybody is up to date on everything that there is to be offered. I think that’s a real testament to Rochester General is that we have really good access to really good care but that human touch, I think, makes a difference and that commitment to what a woman’s going through, I think that is really what separate us.
Bill: Dr. Medeiros, thank you so much for spending time with us today. You’ve been very informative and helpful and thank you for listening to ROC Your Health Radio with Rochester Regional Health. For more information, you can go to www.rochesterregional.com. That’s that www.rochesterregional.com. I am Bill Klaproth. Thanks for listening!
Mastectomy vs Lumpectomy: How Do You Decide Which One is Right for You?
Bill Klaproth (Host): If something suspicious was found during regular routine screening mammogram, how does a woman make that decision if she has a choice between lumpectomy and mastectomy? My guest today is Dr. Lori Medeiros. She is the Medical Director in the Rochester General Breast Center. Dr. Medeiros, thank you for your time. So, if something is found and a woman has a choice between lumpectomy or a mastectomy, how does a woman make that decision?
Dr. Lori Medeiros (Guest): Yes. That is a great question. So, women who are newly diagnosed in breast cancer often have a choice and it’s really important to talk about the fact that these two treatments are equivalent, meaning there is no survival difference whether you opt for lumpectomy or you opt for a mastectomy, as long as you’re able to make that decision. So, there are some women that come in who are newly diagnosed who, unfortunately, don’t have a choice and those are usually women who have many tumors that are in lots different places in the breast; women who’ve had previous treatment with radiation who may not be able to undergo lumpectomy again with radiation therapy; or people who had mantle radiation. So, these are women who’ve had things like Hodgkin’s Lymphoma in the past and that kind of thing. And, there are certain family syndromes or family histories that we worry about a little bit, for people who have a risk developing cancers from radiation. So, lumpectomy is a treatment that is given with radiation or hand-in-hand. Mastectomy often can avoid radiation but sometimes also requires it. So, it’s very individual, but the choice between the two really involves a pretty detailed discussion between the woman and her surgeon, as you can imagine.
Bill: Quickly give us the advantages and disadvantages of a lumpectomy; then quickly the advantages and disadvantages of a mastectomy, just so we break this down to the easiest possible way for somebody to understand the differences between the two.
Dr. Medeiros: Sure. I think the big thing for most women is the addition of radiation therapy. So, remember lumpectomy, or removing the part of the breast involves, later on, doing radiation therapy and that usually starts three to four weeks after surgery or after chemotherapy, as the case maybe. So, radiation therapy is something that’s very well tolerated by most women. It does not involve IV’s. It does not involve any medicines that go into your blood stream. Basically, what it is, is a focused beam that goes to the breast and controls the cancer from coming back. So, there is no hair loss, no nausea. There is no vomiting. There is nothing like that. The main side effects of radiation that women experienced are things like fatigue and changes in the skin. So, that can range from reddening of the skin to darkening of the skin in the general area where we do the radiation. Some women can get like a sunburn and that, generally, is self-resolving. So, most of this things are temporary and they’ll go away. The things that women worry about with radiation are extremely rare. So, what women talk a lot about which are, unfortunately, extremely rare occurrences with radiation, is damage to other organs. With modern radiation, it’s important to realize that when that radiation beam is being delivered, there is a whole team that is there to help deliver that and it’s done with pretty advanced scans that kind keep the beam off the heart, off the lung and that kind of thing. The big thing with radiation from a practical standpoint for most women is that can be time consuming So, we're pretty fortunate feels offers the cutting edge types of radiation that are delivered over very short periods of time. So, these are called “partial breast radiations” and they can be done in as short period of time as 5 days, but conventional radiation can range up to about 6 weeks. So, for a lumpectomy, being able to accept those risks of radiation is an important part of the conversation because that’s all one treatment--the lumpectomy with the radiation. The other thing with lumpectomy, on the flip side that’s the big positive for it, is that you preserve the breast. So, you preserve the nipple, you preserve sensation and you preserve function with that. For most women, it tends to be the less emotional to do the lumpectomy than the mastectomy because it’s not quite as big a change in body image. Even with reconstruction, mastectomy can be quite a change, as you can imagine, in a woman’s body image and in her psychology and a big part of recovery for breast cancer has to do with how you recover emotionally. Lumpectomy tends to be day surgery, which means that you would come in, have the surgery, and go home the same day. So, that can be a big advantage for a lot of women. On the flip side, of course, you do the radiation later on. There is some time commitment there. Anyway, from a cosmetic point of view, a well done lumpectomy generally winds up being better than a mastectomy because, of course, it’s the natural breast. So, you have the natural contour and the natural form. On the flip side with the mastectomy, the pros for that would women who feel like they don’t want to do radiation. Mastectomy can still, of course, require radiation later but it’s usually in situations where we dealing with high risk cancers; so, cancers that have already developed and gone into lymph nodes and things like that, or very large cancers. So, by and large, for the average woman who has a choice between the two, mastectomy may avoid radiation therapy and, for some women, that’s the big driving force. The other part for mastectomy for some woman is the time commitment for the radiation therapy. So, women who live a long distance from a radiation facility or who otherwise just can’t commit to that or can’t lie in that position may opt for mastectomy for that reason. It tends to be a pretty personal choice. What I usually tell patients is that there is no wrong answer here. There is not one that better than the other but it’s important to understand the pros and cons of both because you are making a decision that really is going to impact you, not only in the short term, but, more importantly, in the long term since most breast cancer does quite well, especially when caught in the very early stages. So, these considerations, while they seem maybe trivial in comparison to the breast cancer, so things like cosmetic outcome and body image and that kind of thing are certainly not at the top of woman’s list when she has just been diagnosed but, you know, they’re real considerations and they should be a close second. So, you know, thinking about this is important because it may influence how you would recover emotionally from this.
Bill: When a woman is facing this, do you just leave the decision completely up to them or do you offer guidance as well?
Dr. Medeiros: It depends on the situation because everything is case by case but, generally speaking, for a woman who really has a choice between the two, I generally go through these pros and cons, of course, with the nuances that are specific to each woman in terms of their family history and their lifestyle and that kind of thing. I think, you know, if somebody asks me, I’ll certainly tell them which way I would go, and, you know, my preference is frankly, for a woman who can have the choice between the two, I do find that the lumpectomy with radiation therapy tends to result in a return to normal, getting back to normal, a little bit quite quicker than the mastectomy for most women, but, you know, I’ve seen woman go both ways and they very happy with it. I think the real important piece of this is that, you know, cancer is a very frightening diagnosis. It takes a lot of control away from you. It’s certainly a period of time in your life when it’s in upheaval. So, making a decision that allows you to feel like you’ve really thought about this and you’ve made the decision from the point of view of real self-reflection and thinking what’s best for you is really in the long-term really important because, you know, having that death of control over it or at least partner in that health care decision, I think, overall really is important to overall outcomes.
Bill: And, Dr. Medeiros, can you wrap it up for us? Why should someone choose Rochester General Breast Center for their care?
Dr. Medeiros: I think for me, it’s really the quality of the team. We have really a wonderful group of people here who work, not only collaboratively within the system, but also with other organizations and other groups outside of the system. So, everybody is really focused on trying to get you from point A to point B with as little emotional trauma as you can, given what you’re dealing with. That’s the part I think really makes a difference because, of course, we use the most advanced treatment and, of course, everybody is up to date on everything that there is to be offered. I think that’s a real testament to Rochester General is that we have really good access to really good care but that human touch, I think, makes a difference and that commitment to what a woman’s going through, I think that is really what separate us.
Bill: Dr. Medeiros, thank you so much for spending time with us today. You’ve been very informative and helpful and thank you for listening to ROC Your Health Radio with Rochester Regional Health. For more information, you can go to www.rochesterregional.com. That’s that www.rochesterregional.com. I am Bill Klaproth. Thanks for listening!