Q. What are the different types of breast cancer, and how are they treated?
A. This question came in last month and I addressed part one, the different types. This month I promised to discuss part two, the various treatments. That part of the question was actually, “Should I get a mastectomy or a lumpectomy?”
I think to best answer the question we should first look at the history of surgery for breast cancer. In the old days we used to do mastectomies on everyone – and they were quite radical.
Over time, doctors asked whether we could do a “less radical” mastectomy and set upon research projects to answer that question. They found out that the answer was “yes”, so they went further. They posed the question of instead of doing a mastectomy, can we just take out the lump and see how the woman does? We found over time that a lumpectomy, followed by radiation of the affected breast, worked well. It removed the cancer, and in the vast majority of cases the cancer never returned.
We found that when the cancer did return, it did not affect that woman’s life expectancy. Maybe five or 10 years later a very small percentage of lumpectomy women had a recurrence and then had to get a mastectomy, but her life expectancy was not altered. Death rates were no different for women who had mastectomies over women who first had lumpectomies and radiation.
We also found one other thing that may be important – for women who initially had a mastectomy, recurrence rates were lower than lumpectomy, but they were not entirely zero. There is still a very small, but lower chance, that a woman with a mastectomy could still get a recurrence. So lumpectomy with radiation was a viable option.
Of course, this is a generalization. You really do have to talk to your surgeon and listen to his or her advice. Every situation is different, and I am not trying to punt the question. Some women are not able to get a lumpectomy because of various factors. The tumor has to be small and not large (hence get your yearly mammogram for early detection), staging is important, and some women, for various reasons, do not want the followup radiation or the psychological stress that naturally comes around with subsequent yearly checkups.
There are also other factors involved in treatment of breast cancer, such as who needs chemotherapy and who does not, when do we remove lymph nodes in the underarm, and how many need to come out. I will address these down the road as well, so please stay tuned and remember:
Friends don’t let friends skip mammograms.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center.