You have received a diagnosis of breast cancer. We’re so sorry. We’ve been there, and we know how you feel. This is one of the most difficult moments a woman can experience. You may never have felt more vulnerable in your life. And unfortunately, you are likely being called upon to make quick treatment decisions.
You would like to believe that your doctor is a leading expert in every aspect of your cancer care. You would feel less overwhelmed, and it would make everything so much easier. But the reality is that some of the choices ahead of you are best made by you and not necessarily just your doctor.
Odds are that one day — hopefully soon — you will have this cancer nightmare behind you and will go on to live a long, healthy, and happy life. Your chances may increase if you take the time now to educate yourself about your options. Try not to feel rushed into making choices before you are ready. The fact that you are here, reading this now, shows you are at the helm — despite turbulent seas — ready to take control of your destiny.
Lumpectomy or Mastectomy?
Lumpectomy is the surgical procedure where your doctor removes only the cancerous tissue from your breast and an adjoining rim of healthy tissue to provide a margin of safety. Lumpectomy alone or combined with radiation can provide significant conservation of your breast. Research has shown that if you meet all four of the following conditions, then a lumpectomy and radiation will give you the same odds of survival as a mastectomy, though the chance of local recurrence is slightly higher:
1) Early-stage breast cancer
2) Only one tumor
3) Tumor less than four centimeters (about 1 1/2 inches)
4) Clear surgical margins
The last three conditions cannot be determined for sure until during your lumpectomy surgery. A preliminary determination about what type of breast cancer you have occurs at this time. A preliminary decision may have also been made if you had a needle biopsy. Final determination will not take place, however, until a more thorough examination of the tumor sample by your pathologist in the days following surgery.
After a lumpectomy, your surgeon may tell you everything went well, your cancer appeared to be small, early stage, non-invasive, and that he/she was able to remove it all, as well as a clear margin. In this case, you and your doctor will likely decide no further surgical treatment is necessary.
For some women, a lumpectomy may leave only a small scar or dimple. For others, it may cause a change in size or shape of the breast. If the difference causes you concern, you can use a partial prosthesis or seek out a plastic surgeon for enhancement of the affected breast or have your other breast reduced.
Most women treated by lumpectomy must do a course of radiation treatments after the surgery. How many treatments you have and how extensive they are depends upon several factors, including how large the cancer was and where it was located, as well as what type of technology is available where you receive your treatments. You may need to set aside six or more weeks for daily radiation appointments, or under some circumstances, they may be able to be completed in just a week.
There are side-effects from radiation therapy. Radiation causes changes in the chest skin, similar to a very serious sunburn, causing pain and possibly blistering. Depending upon how and where it is targeted, it can also damage the heart, lungs and/or other tissues and organs. It is very important that you obtain specific information about the likely effects of your radiation protocol prior to making the decision that lumpectomy combined with radiation is the treatment you want. If you have had previous radiation, you may have already had the maximum lifetime dose. Discuss all of this with your doctor.
The mastectomy of the 21st century is a vast improvement over the disfiguring and disabling procedure considered the norm for the women of our mothers’ or grandmothers’ generations. That surgery entailed removal of not only the breast tissue, but also all of the pectoralis muscles and lymph nodes up to the collarbone. Now chemotherapy can shrink a large tumor and any removal of muscle is minimized. The least possible number of lymph nodes are removed, which may be limited to the sentinel node, used to determine if the cancer has spread beyond the breast.
A mastectomy may be your only reasonable surgical option if your surgeon finds that your cancer does not meet all four of the conditions above — perhaps the cancer is not early stage, or the tumor is larger than 4 centimeters, there is more than one tumor, or the amount of tissue that must be removed to obtain cancer-free margins is so substantial that the cosmetic results of trying to save the breast would be unacceptable.
But there are other circumstances that may cause a woman to consider elective or prophylactic (preventative) mastectomy, even if all of the traditional medical conditions for lumpectomy are met:
- · If the type of cancer you have raises your risk of recurrence in either breast, this might influence your decision. Some women are uncomfortable relying upon surveillance to pick up a new future breast cancer, especially if the type of cancer she already had was barely detected by mammogram or ultrasound. Some insurance companies refuse to pay for periodic breast MRIs, which may be the most reliable method of detecting some types of tumors.
- ·If you have a strong family history of cancer, consider having a genetic test to see if you carry the genetic mutation on BRCA1 or BRCA2. Both of these conditions greatly increase your chances of another breast cancer, as well as ovarian cancer. You will want to discuss a positive result with a genetic counselor. Knowing your genetic predisposition may help you decide between lumpectomy or mastectomy of one or both breasts.
- ·You may have been under close surveillance for years and have had multiple biopsies. Now that you’ve been diagnosed with cancer, you may decide it’s time to “get off the roller coaster” as so many women put it, thereby greatly reducing your risk of ever having to deal with breast cancer again.
These are your breasts, your feelings and your life. Take the time to sort out your priorities and your emotions. Discuss your decision with your doctors and people you trust. But, ultimately, the decision must be yours.
This is also the best time to learn about the different types of breast reconstruction now available. This knowledge may not only influence what type of reconstruction you choose, if mastectomy becomes medically necessary, but also whether mastectomy may be a treatment option you want to consider electively. Also, your type of reconstruction could influence how your mastectomy is performed and which surgeon you choose to do it.