What has a better outcome? A Mastectomy or a Lumpectomy with Radiation Therapy?

Mastectomy

Definition: Mastectomy is the removal of the whole breast(s). (No muscles are removed from beneath the breast). [5]

Sources

Breast Conservation Therapy (Lumpectomy w/ Radiation Therapy)

Lumpectomy

Radiation Therapy

  1. Mayo Clinic Website (L): https://www.mayoclinic.org/tests-procedures/lumpectomy/about/pac-20394650
  1. Mayo Clinic Website (R): https://www.mayoclinic.org/tests-procedures/radiation-therapy-for-breast-cancer/about/pac-20384940
  1. Introduction to the Radiation Sciences (lecture slides)

Definition: Therapists use precisely administered high-powered radiation to shrink tumors and kill cancer cells. [1].

Definition: Is surgery to remove cancer or other abnormal tissue from the breast. [2]

UNLIKE MASTECTOMY, Lumpectomy only removes the tumor and a small amount of normal breast tissue surrounding it (to help ensure that all the cancer or other abnormal tissue is removed). [3] [2]

Is an effective way to reduce the risk of breast cancer recurring after surgery. It kills remaining cancer cells. [3]

Common Side effects: mild to moderate fatigue, skin irritation, breast swelling, changes in skin sensation. [3]

NOTE: Side effects from radiation therapy differ significantly depending on the type of treatment and which tissues are treated. [3]

  1. Mayo Clinic Website (M) CHECK : https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670
  1. Breast Conserving Surgery (Scholarly Articles) CHECK: https://scholar.google.com/scholar?q=breast+conserving+surgery&hl=en&as_sdt=0&as_vis=1&oi=scholart
  1. Breastcancer.org: Lumpectomy v. Mastectomy? CHECK https://www.breastcancer.org/treatment/surgery/mast_vs_lump

Lumpectomy helps confirm a diagnosis of cancer or rule it out. The goal of a Lumpectomy is to remove cancer while maintaining the breast's appearance [2]

Lumpectomy is also a first treatment option for some women with early-stage breast cancer. [2]

Studies indicate that lumpectomy is as effective a treatment in preventing a recurrence of breast cancer as removal of the entire breast for women with early-stage breast cancer. [2]

Doctor may recommend Lumpectomy if its proven that there is cancer and that the cancer is believed to be small and early stage. [2]

You may not be a candidate for Lumpectomy if you:

  1. Have a history of scleroderma
  2. Have a history of systemic lupus erythematosus
  3. Have two or more tumors in different quadrants of your breast that cannot be removed with a single wide excision, which could affect the appearance of your breast
  4. Have previously had radiation treatment to the breast region, which would make further radiation treatments too risky
  5. Have cancer spread throughout your breast and overlying skin, since lumpectomy would be unlikely to remove the cancer completely
  6. Have a large tumor and small breasts, which may cause a poor cosmetic result
  7. Don't have access to radiation therapy [2]

Risks: bleeding, infection, pain, temporary swelling, tenderness, formation of hard scar tissue at the surgical site, change in the shape and appearance of the breast (particularly if a large portion is removed). [2]

Lymph nodes are often removed during surgery to determine whether cancer has spread beyond the breast. Options include axillary node dissection and sentinel lymph node biopsy [2]

Mastectomy is done as a way to treat or prevent breast cancer if at a high risk for it. [4]

Breast reconstruction: surgery to restore shape to the breast. Can be done at the same time as or after a Mastectomy (implant). [4]

In clinical trials it was found that lumpectomy with radiation therapy was just as effective as having the whole breast removed. [3]

Mastectomy treatment examples: For DCIS, Stage I and II breast cancer, Stage III (locally advanced) breast cancer- after chemo, inflammatory breast cancer- after chemo, Paget's disease, locally recurrent breast cancer. [4]

MASTECTOMY INSTEAD OF L+R: 1. You have widespread or malignant-appearing calcium deposits (microcalcifications) throughout the breast that have been determined to be cancer after a breast biopsy. 2. You're pregnant and radiation creates an unacceptable risk to your unborn child. 3. You've had a lumpectomy, but cancer is still present at the edges (margin) of the operated area and there is concern about cancer extending to elsewhere in the breast. 4.You carry a gene mutation that gives you a high risk of developing a second cancer in your breast. [4]

A risk-reducing mastectomy involves removing both of your breasts and significantly reduces your risk of developing breast cancer in the future. [4]

Risk: bleeding, infection, pain, SWELLING in the arm if you have an axillary node dissection, formation of hard scar tissue at the surgical site, SHOULDER pain and stiffness, numbness from lymph node removal, HEMATOMA. [4]

Breast reconstruction may involve using breast expanders with saline or silicone implants, using the body's own tissue, or both. [4]

Checklist: Describe each procedure, look at how factual the articles are, look at what rhetorical devices are used when they talk about which procedure is better, pros and cons of each treatment, factors to influence you to choose one side over the other.

"They tell the general public that both M and L+R are equally safe, but that is not true. When diagnosed with breast cancer you need to do research because every cancer is different and requires different treatment."

Pros and Cons

Pros:

Cons:

With a Lumpectomy there is a higher chance that the breast cancer can come back and spread (CHECK)

Mastectomy, for the most part, does not require radiation therapy.

Lumpectomy is not an option for everyone. [4]

A mastectomy without reconstruction only takes 1-3hrs and you can leave the same day. However if you get both breast removed with reconstruction you may stay the night for several nights [4].

Reasons why women who have mastectomy decide to have or not to have breast reconstruction (CHECK):https://www.ncbi.nlm.nih.gov/pubmed/9623821

What does it mean by effective? Better life for patient afterwards or better removal of breast cancer?