Could Less Be More When It Comes to Breast Cancer Surgery?

It’s important to weigh all your options before making the decision to pursue treatment.

a female patient speaks with a female doctor

Updated on May 27, 2022.

If you’ve been diagnosed with breast cancer, you have treatment options to consider. Do you opt for breast-conserving surgery (also known as lumpectomy)? Or does having your breast or breasts completely removed (a mastectomy) make more sense?

Lumpectomy is the recommended treatment for most women with early-stage cancer. But many choose mastectomy instead.

A 2021 survey published in the journal Cureus indicated that among 1,064 people deciding between a mastectomy and lumpectomy, 56.9 percent decided to have a mastectomy and 43.1 percent chose lumpectomy.

Many patients make that choice with the idea that the more comprehensive procedure will yield better survival odds. But research has shown that this is not necessarily the case.

In a 2014 study published in JAMA Surgery, researchers looked at a decade’s worth of data from more than 130,000 women who were treated for early-stage breast cancer (specifically early stage ductal carcinoma). After 10 years, about 94 percent of women who had lumpectomy with radiation had not died of breast cancer. That’s compared with 90 percent of women who had a mastectomy and 83 percent of women who had mastectomy and radiation. (These are called 10-year survival rates.)

A 2021 study in JAMA Surgery from Sweden of nearly 49,000 women showed that lumpectomy offered better 5-year survival rates than mastectomy for early-stage cancers. “Early-stage” is the key term here. More aggressive breast cancer subtypes may require more aggressive treatments.

These studies add to decades of research showing that lumpectomy is at least as effective as mastectomy—and maybe more—for early breast cancers.

A key complicating factor to consider, though, is breast cancer recurrence. Those who opt for lumpectomy may experience a recurrence and be referred for a mastectomy, which increases the risk of complications like infection as well as the cost of additional surgeries.

Weighing your breast cancer surgery options

When deciding between a lumpectomy and mastectomy, the American Cancer Society (ACS) recommends you ask your surgeon several key questions:

  • Is breast-conserving surgery (lumpectomy) an option for me? Why or why not?
  • What are the positive and negative aspects of breast-conserving surgery versus mastectomy?
  • How many surgeries like mine have you done?
  • Will you have to take out lymph nodes? What side effects might lymph node removal cause?
  • How long will I be in the hospital?
  • Will I have stitches or staples at the surgery site? Will there be a drain (tube) coming out of the site?
  • How do I care for the surgery site? Will I need someone to help me?
  • What will the scar look like?
  • What additional treatments might I need?
  • What are the options for breast reconstruction?

It’s important to recognize that breast-conserving surgery isn’t an option for everyone. Some pregnant people who have breast cancer may be advised to have a mastectomy instead of breast-conserving surgery. If you have previously had radiation therapy of the same breast or if you have inflammatory breast cancer, the ACS notes that your healthcare provider (HCP) may also recommend mastectomy instead.

Most importantly, if you’re diagnosed with breast cancer, it’s crucial to try not to make a choice based on fear. Discuss your options with your HCP so that you can make an informed decision and find the right treatment for you. It may also help to connect with online and in-person support groups through the ACS, Susan G. Komen, and other organizations.

 

Article sources open article sources

Admoun C, Mayrovitz H (October 02, 2021) Choosing Mastectomy vs. Lumpectomy-With-Radiation: Experiences of Breast Cancer Survivors. Cureus 13(10): e18433.
Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer. JAMA Surg. 2014;149(3):267–274.
de Boniface J, Szulkin R, Johansson ALV. Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status: A Swedish National 6-Year Follow-up of 48 986 Women. JAMA Surg. 2021;156(7):628–637.
American Cancer Society. Questions to Ask Your Doctor About Breast Cancer. Last Revised: November 8, 2021.

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