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Smaller Surgery Even Better

Posted 1/19/2014

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  It has been decades since the first studies from Dr. Fisher in Pittsburgh reported that women who were treated with lumpectomy/wide excision and radiation did just as well as those who had a mastectomy. Yes, there will always be some women who need a mastectomy (more than one cancer in the breast, a second cancer in a breast that has been previously radiated. women who carry a gene mutation, women with very large tumors etc.), but most women can again be reassured that smaller surgery is just as safe.

  When I first began to work at BID (then BI) in 1979, we were one of only three hospitals in the country that offered the wide excision/radiation option. For the first few years of my employment, I knew many women who lived elsewhere and came to Boston to save their breasts. We had arrangements with a number of nearby hotels, so that women could stay at a reduced rate. It was always hard, however, as they were far from home and their usual support systems.

  Now there a new study looking at women who were treated with mastectomy vs. lumpectomy/radiation between 1998 an 2008 reports that women who had the smaller surgery actually had a slightly better survival (94% vs 90%). I am especially glad to hear this now since there is a growing trend of women opting for single or even bilateral mastectomies when they are not medically suggested. Clearly, it is a difficult choice for anyone, and each of us knows best what is best for one's self. But it is important that our doctors have even more data and information to help us make the most informed decision.

  From Reuters: More evidence lumpectomy for early breast cancer is safe

NEW YORK (Reuters Health) - A new review of a decade's worth of U.S. cancer statistics finds that women who got breast-conserving surgery and radiation to treat early-stage cancer were less likely to die from breast cancer during the next 10 years than those who had their
breasts removed.
Researchers found that 94 percent of women who had lumpectomy and radiation between 1998 and 2008 had not died of breast cancer after 10 years, compared to about 90 percent of the women who had mastectomy, with or without radiation.
"We can see what's happening in modern-day practice," Dr. Shailesh Agarwal said. "Patients who are undergoing breast conservation therapy - versus patients who are undergoing mastectomy - are having better survival."
Agarwal, an associate professor of plastic and reconstructive surgery at the University of Utah School of Medicine in Salt Lake City, is the study's lead author.
His team's report, published in the journal JAMA Surgery, is not the first to point out that women who have lumpectomy and radiation for breast cancer appear to live longer than others.

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  • Patricia Hogan said:
    1/19/2014 11:57 AM

    This report is very reassuring regarding the safety of having breast saving surgery. But it ignores the possible dangers and life-long side effects of radiation, which I believe is recommended for most women post-lumpectomy. Are these usually discussed in as much depth as the surgery options?