Decades ago a diagnosis of breast cancer was devastating and almost always meant that a woman would undergo a mastectomy, the removal of the entire breast. Today with regular screening mammograms, breast cancers are often caught in earlier stages, allowing women the choice between a lumpectomy (removal of part of the breast) and a mastectomy.
Joining the show is Jessica Young, MD. She is a breast surgeon with Roswell Park Comprehensive Cancer Center. She is here to discuss the difference between a lumpectomy and a mastectomy and to help educate you to make the best decision based on your diagnosis.
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Lumpectomy vs. Mastectomy
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Learn more about Jessica Young, MD
Jessica Young, MD
Jessica Young, MD., joined the Surgical Oncology faculty at Roswell Park Comprehensive Cancer Center in 2013 as an Assistant Professor of Surgical Oncology in Breast Surgery. I earned my medical degree from Jefferson Medical College in Philadelphia, Pennsylvania.Learn more about Jessica Young, MD
Transcription:
Lumpectomy vs. Mastectomy
Bill Klaproth (Host): Decades ago, a diagnosis of breast cancer was devastating and almost always meant that a woman would undergo a mastectomy, removal of the entire breast. Today, with regular screening, breast cancers are often caught in earlier stages allowing women the choice between a lumpectomy or mastectomy. Here to talk with us about the difference between the two, is Dr. Jessica Young, Assistant Professor of Surgical Oncology, Department of Breast Surgery at Roswell Park Comprehensive Cancer Center. Dr. Young, thanks for your time. So, what is the difference between a lumpectomy and a mastectomy?
Dr. Jessica Young, MD (Guest): Well these are actually two very different surgeries. They actually have differences in terms of whether you are thinking about survival and things like that versus also cosmetically and the actual surgery itself. So, a lumpectomy itself, is just the removal of the area of cancer with some normal tissue around it, but it leaves your breast relatively intact, so your breast still looks like a breast that has a nipple and you usually don’t need any reconstruction for it. A mastectomy, is when you remove the entire breast and it may or may not include the nipple, but it is obviously a much larger surgery and is usually more disfiguring and you may or may not get reconstruction with the mastectomy, but it is still a larger surgery with more recovery and more painful than a lumpectomy tends to be.
Bill: And why would a surgeon recommend one operation over the other?
Dr. Young: Well, that’s a great question. As you had mentioned in your intro, more and more, we are finding the breast cancers at earlier stages, which generally means that it is a smaller breast cancer and really there is no specific size of a breast cancer at which I would say you have to have a mastectomy. It really is relative to how large the cancer is in relation to how large your breast is. So, we come in all different shapes and sizes, so that may be different for different people. And it is my job to be able to tell you whether you would still look good cosmetically with the lumpectomy or whether you have to have a mastectomy because the disease process may be too extensive. Alternately, the other reason why people may choose one over the other is in terms of what they think whether they will survive longer. So, there are a lot of different myths that are out there, and people think that if they do a larger surgery, they may survive longer, they may be able to avoid other therapy such as chemotherapy and that’s really not true. So, in terms of survival, when the studies came back a couple of decades ago really, we looked at lumpectomies with radiation treatments versus mastectomies and for the same types of cancers essentially and really the survival is the same in either situation. So, that’s I think fairly reassuring for most patients. The difference is actually that when you have a lumpectomy, you may have a higher chance that breast cancer will come back at some time in your lifetime. So, generally, that’s probably maybe about a 10% to 15% chance if you get a lumpectomy with radiation versus having a mastectomy where you have maybe about a 1% to 2% chance of breast cancer coming back at some point. That may sound a little weird that if breast cancer comes back will you survive as long? But generally speaking, as long as you are treated for it; you should survive as long. So, that’s why those outcomes were equal survival in the large trials.
Bill: Right, so if you had to give someone a pro and a con of each; what would those be?
Dr. Young: So, I think for a lumpectomy; the pro is that it is a smaller surgery, so it is less anesthesia. It is less cosmetically disfiguring. I think we know that lifestyle – in terms of lifestyle; it is definitely less disfiguring, and people have a better quality of life that’s been shown in different studies. It does on the con side of things, you will likely need to have radiation, so you don’t necessarily avoid that, and you do have a slightly higher chance of recurrence of breast cancer.
With the mastectomy; it is sort of the opposite, so it’s a much larger surgery. It usually requires an overnight stay in the hospital. You are fairly disfigured and if you decide to have reconstruction, usually you will need to have further surgeries down the road, so it is not just the quick instant process, generally speaking and it is obviously more painful, but it does decrease your risk of recurrence the most. So, if your number one fear in the world is ever getting breast cancer again; then mastectomy may be the more ideal option for you. And so really, they are two very, very different surgeries and it really depends on what people are focusing on the most in terms of trying to make a decision. And it’s a really hard decision actually. It is probably the hardest thing that my patients usually have to go through.
Bill: Absolutely. So, in thinking of the other treatments, chemo and radiation; how do those play a role in deciding which operation might be best?
Dr. Young: So, that’s a great question. The first thing that I want to emphasize is that no matter which surgery you choose, it does not help to determine whether you are going to get chemotherapy or not. That’s a huge, huge point that I think people just get confused about and it’s a huge point for me to make when I am educating my patients when they are trying to make their decision. So, chemotherapy is about how much cancer you have, so how large it is, whether it went to the lymph nodes or not and what kind of cancer you have. It is not about what surgery you choose to remove it. So, however – whatever surgery you decide to choose; it’s still going to be the same amount of cancer and same size of cancer that comes out and so again, you cannot really influence the decision for chemotherapy by choosing a smaller or larger surgery. So, I think that’s a super important point. In terms of radiation, most of the time, patients who have mastectomies don’t require radiation. However, there are some cases where they may require radiation, if they have very large cancers or if they have a lot of lymph nodes positive; those are two very common scenarios for needing radiation even if you have a mastectomy. But in general, most people who have a mastectomy will likely not need radiation, so if that is part of your decision point, then it is something to consider. Or if you for some reason cannot receive radiation then mastectomy might be the choice for you. So, there are some people with connective tissue disorders or maybe people who have previously received radiation either for some other malignancy or perhaps for a previous breast cancer, and you can’t get radiation again; then the choice would generally be a mastectomy. Everyone who has a lumpectomy generally will undergo radiation except for some populations we are starting to do less and less radiation for. For example, favorable cancers in women over the age of 70, but in general, when you are thinking lumpectomy; you should think that you are going to get radiation.
Bill: Well those are really good considerations and you mentioned educating your patients. What are good resources for potential patients to learn more about both operations?
Dr. Young: So, there are a number of different resources out there that are available. The first thing I would say is just to be really careful about where you are getting your information from. There is just so much information on the internet, especially; but if you are going to look on the internet to help you decide; there are a lot of very large websites that are very reputable that I would start at. The American Cancer Society or the Susan G. Komen have very good websites that have a lot of education and information. If you were to come to like the Roswell Park website; we have information on that as well and I know a number of other cancer institutes around the country have information such as MD Anderson or Memorial Sloan Kettering in New York. I would start at a well-known institute’s website would probably be the best thing to do. And really, also just really listen hard to what your physician has to say because it is often overwhelming when you are at the visits, but if you are able to have people with you who are able to also hear what the physician is saying or if you take notes or record it; it will give you a deeper sense of what they are really offering you.
Bill: You know earlier, you mentioned what a tough decision this is for women. How do you counsel them when they come to you? How do you advise them on what is their main concerns of each? How do you help them out in that situation when they are trying to decide?
Dr. Young: So, sometimes certain patients – so for example sometimes patients are not always a candidate to have a lumpectomy and so in that case, I will counsel them to have the mastectomy and what to expect. In some patients, they may have other health issues that preclude them perhaps from having a larger surgery or we think it is safer if you do a smaller surgery, it is less time on the operating room table and so forth and so that may push me more towards that. But in general, I really try to hear what the patient’s largest fears are or what they are expecting and I think what helps patients is that there is a statistic that about three quarters of patients who are candidates to have lumpectomy go ahead and have the lumpectomies and so I think women who are thinking about lumpectomies but fear that they are leaving possible cancer cells behind and everything and that this might be an issue in the future; they should know that most women who are candidates to have the lumpectomy do go forward and have that and do very well. So, I really try to just listen to what the patient really wants. I mean there are some women who come in and say they are absolutely having a mastectomy, but it is because they don’t maybe know all the statistics and the facts behind it and they are basing that decision out of a lot of fear, so it is just a lot of education and then going through it with them and helping them to make that decision.
Bill: Such important information and luckily, we have people like you to help counsel people through these very important decisions. Dr. Young, thank you so much for your time today. We really appreciate it. For more information you can visit www.roswellpark.org , that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
Lumpectomy vs. Mastectomy
Bill Klaproth (Host): Decades ago, a diagnosis of breast cancer was devastating and almost always meant that a woman would undergo a mastectomy, removal of the entire breast. Today, with regular screening, breast cancers are often caught in earlier stages allowing women the choice between a lumpectomy or mastectomy. Here to talk with us about the difference between the two, is Dr. Jessica Young, Assistant Professor of Surgical Oncology, Department of Breast Surgery at Roswell Park Comprehensive Cancer Center. Dr. Young, thanks for your time. So, what is the difference between a lumpectomy and a mastectomy?
Dr. Jessica Young, MD (Guest): Well these are actually two very different surgeries. They actually have differences in terms of whether you are thinking about survival and things like that versus also cosmetically and the actual surgery itself. So, a lumpectomy itself, is just the removal of the area of cancer with some normal tissue around it, but it leaves your breast relatively intact, so your breast still looks like a breast that has a nipple and you usually don’t need any reconstruction for it. A mastectomy, is when you remove the entire breast and it may or may not include the nipple, but it is obviously a much larger surgery and is usually more disfiguring and you may or may not get reconstruction with the mastectomy, but it is still a larger surgery with more recovery and more painful than a lumpectomy tends to be.
Bill: And why would a surgeon recommend one operation over the other?
Dr. Young: Well, that’s a great question. As you had mentioned in your intro, more and more, we are finding the breast cancers at earlier stages, which generally means that it is a smaller breast cancer and really there is no specific size of a breast cancer at which I would say you have to have a mastectomy. It really is relative to how large the cancer is in relation to how large your breast is. So, we come in all different shapes and sizes, so that may be different for different people. And it is my job to be able to tell you whether you would still look good cosmetically with the lumpectomy or whether you have to have a mastectomy because the disease process may be too extensive. Alternately, the other reason why people may choose one over the other is in terms of what they think whether they will survive longer. So, there are a lot of different myths that are out there, and people think that if they do a larger surgery, they may survive longer, they may be able to avoid other therapy such as chemotherapy and that’s really not true. So, in terms of survival, when the studies came back a couple of decades ago really, we looked at lumpectomies with radiation treatments versus mastectomies and for the same types of cancers essentially and really the survival is the same in either situation. So, that’s I think fairly reassuring for most patients. The difference is actually that when you have a lumpectomy, you may have a higher chance that breast cancer will come back at some time in your lifetime. So, generally, that’s probably maybe about a 10% to 15% chance if you get a lumpectomy with radiation versus having a mastectomy where you have maybe about a 1% to 2% chance of breast cancer coming back at some point. That may sound a little weird that if breast cancer comes back will you survive as long? But generally speaking, as long as you are treated for it; you should survive as long. So, that’s why those outcomes were equal survival in the large trials.
Bill: Right, so if you had to give someone a pro and a con of each; what would those be?
Dr. Young: So, I think for a lumpectomy; the pro is that it is a smaller surgery, so it is less anesthesia. It is less cosmetically disfiguring. I think we know that lifestyle – in terms of lifestyle; it is definitely less disfiguring, and people have a better quality of life that’s been shown in different studies. It does on the con side of things, you will likely need to have radiation, so you don’t necessarily avoid that, and you do have a slightly higher chance of recurrence of breast cancer.
With the mastectomy; it is sort of the opposite, so it’s a much larger surgery. It usually requires an overnight stay in the hospital. You are fairly disfigured and if you decide to have reconstruction, usually you will need to have further surgeries down the road, so it is not just the quick instant process, generally speaking and it is obviously more painful, but it does decrease your risk of recurrence the most. So, if your number one fear in the world is ever getting breast cancer again; then mastectomy may be the more ideal option for you. And so really, they are two very, very different surgeries and it really depends on what people are focusing on the most in terms of trying to make a decision. And it’s a really hard decision actually. It is probably the hardest thing that my patients usually have to go through.
Bill: Absolutely. So, in thinking of the other treatments, chemo and radiation; how do those play a role in deciding which operation might be best?
Dr. Young: So, that’s a great question. The first thing that I want to emphasize is that no matter which surgery you choose, it does not help to determine whether you are going to get chemotherapy or not. That’s a huge, huge point that I think people just get confused about and it’s a huge point for me to make when I am educating my patients when they are trying to make their decision. So, chemotherapy is about how much cancer you have, so how large it is, whether it went to the lymph nodes or not and what kind of cancer you have. It is not about what surgery you choose to remove it. So, however – whatever surgery you decide to choose; it’s still going to be the same amount of cancer and same size of cancer that comes out and so again, you cannot really influence the decision for chemotherapy by choosing a smaller or larger surgery. So, I think that’s a super important point. In terms of radiation, most of the time, patients who have mastectomies don’t require radiation. However, there are some cases where they may require radiation, if they have very large cancers or if they have a lot of lymph nodes positive; those are two very common scenarios for needing radiation even if you have a mastectomy. But in general, most people who have a mastectomy will likely not need radiation, so if that is part of your decision point, then it is something to consider. Or if you for some reason cannot receive radiation then mastectomy might be the choice for you. So, there are some people with connective tissue disorders or maybe people who have previously received radiation either for some other malignancy or perhaps for a previous breast cancer, and you can’t get radiation again; then the choice would generally be a mastectomy. Everyone who has a lumpectomy generally will undergo radiation except for some populations we are starting to do less and less radiation for. For example, favorable cancers in women over the age of 70, but in general, when you are thinking lumpectomy; you should think that you are going to get radiation.
Bill: Well those are really good considerations and you mentioned educating your patients. What are good resources for potential patients to learn more about both operations?
Dr. Young: So, there are a number of different resources out there that are available. The first thing I would say is just to be really careful about where you are getting your information from. There is just so much information on the internet, especially; but if you are going to look on the internet to help you decide; there are a lot of very large websites that are very reputable that I would start at. The American Cancer Society or the Susan G. Komen have very good websites that have a lot of education and information. If you were to come to like the Roswell Park website; we have information on that as well and I know a number of other cancer institutes around the country have information such as MD Anderson or Memorial Sloan Kettering in New York. I would start at a well-known institute’s website would probably be the best thing to do. And really, also just really listen hard to what your physician has to say because it is often overwhelming when you are at the visits, but if you are able to have people with you who are able to also hear what the physician is saying or if you take notes or record it; it will give you a deeper sense of what they are really offering you.
Bill: You know earlier, you mentioned what a tough decision this is for women. How do you counsel them when they come to you? How do you advise them on what is their main concerns of each? How do you help them out in that situation when they are trying to decide?
Dr. Young: So, sometimes certain patients – so for example sometimes patients are not always a candidate to have a lumpectomy and so in that case, I will counsel them to have the mastectomy and what to expect. In some patients, they may have other health issues that preclude them perhaps from having a larger surgery or we think it is safer if you do a smaller surgery, it is less time on the operating room table and so forth and so that may push me more towards that. But in general, I really try to hear what the patient’s largest fears are or what they are expecting and I think what helps patients is that there is a statistic that about three quarters of patients who are candidates to have lumpectomy go ahead and have the lumpectomies and so I think women who are thinking about lumpectomies but fear that they are leaving possible cancer cells behind and everything and that this might be an issue in the future; they should know that most women who are candidates to have the lumpectomy do go forward and have that and do very well. So, I really try to just listen to what the patient really wants. I mean there are some women who come in and say they are absolutely having a mastectomy, but it is because they don’t maybe know all the statistics and the facts behind it and they are basing that decision out of a lot of fear, so it is just a lot of education and then going through it with them and helping them to make that decision.
Bill: Such important information and luckily, we have people like you to help counsel people through these very important decisions. Dr. Young, thank you so much for your time today. We really appreciate it. For more information you can visit www.roswellpark.org , that’s www.roswellpark.org . You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.