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More women may be eligible for breast-conserving surgery

Size of tumor not always key

Karen Miller
More women may be eligible for breast-conserving surgery
(Photo: Shutterstock/Zdenka Darula)

The surgical treatment for breast cancer has improved significantly through the years. At one time the gold standard was radical mastectomy, which involved removing the entire breast, all of the lymph nodes under the arm and the chest muscles. The surgery saved lives, but was somewhat debilitating. The loss of the pectoral muscles resulted in reduced strength of the shoulder and removal of all the lymph nodes often caused swelling in the arm. This technique is rarely practised today.

Radical mastectomy has been replaced by two other types of surgery. In total, or simple, mastectomy the entire breast and the lining of the chest muscle are removed. According to the website Susan G. Komen, total mastectomy is used to treat ductal carcinoma in situ (cancer confined to the milk ducts of the breast) and for breast cancer recurrence. It is also used for women at high risk for the disease who choose to remove the breast as a preventive tactic.

The other type of surgery is modified radical mastectomy. This is similar to total mastectomy but also involves removal of some lymph nodes in the underarm. This procedure may be used for advanced or inflammatory breast cancer.

Mastectomy is not the only surgical treatment for breast cancer. In some cases, the patient undergoes a lumpectomy, or breast-conserving surgery, in which only the tumor and a wide area around the tumor are removed. Lumpectomy is typically accompanied by radiation to make sure all the cancer cells have been destroyed.

Several studies have found that survival rates are similar for mastectomies and lumpectomies.

Not all cases of breast cancer are eligible for lumpectomies. Generally, the procedure has been limited to tumors 5 centimeters (two inches) or smaller. But new research from Fox Chase Cancer Center in Philadelphia found that size may not always matter.

Researchers examined information on roughly 5,700 patients with tumors larger than 5 centimeters who underwent breast surgery between 1992 and 2009. Almost 15 percent of these patients had been treated with lumpectomy rather than mastectomy. The analysis found that the adjusted overall survival for those who had lumpectomies was the same as those who had mastectomies. The median follow-up period was seven years.

According to lead investigator Dr. Richard J. Bleicher, many surgeons do not perform lumpectomies for patients with large tumors, even when their breast size is generous enough to accommodate the remove of such a large tumor. “We now have data demonstrating that breast conservation appears safe and should remain an option when the surgeon feels that the patient’s breast size can accommodate the resection,” he said.

The researchers further concluded that there may be psychological considerations for this type of surgery. It’s been shown that there is a correlation between breast-conserving treatment and improved quality of life due to body image and treatment satisfaction.