Our Summary

This research paper is about a study that looked at the best treatment options for breast cancer that comes back after initial treatment. The two options studied were salvage lumpectomy (SL), where only the tumor and some surrounding tissue are removed, and mastectomy, where the whole breast is removed.

The study involved 121 patients who had previously received breast-conserving treatment and later experienced a return of the tumor in the same breast. Of these, 47 had a SL and 74 had a mastectomy.

After following up with these patients for an average of 14 years, the study found that a slightly higher percentage of those who had a SL experienced another return of the cancer. However, nearly 96% of the SL patients were alive and showed no evidence of disease, and 85% had not had to have a mastectomy.

In contrast, 87% of those who had a mastectomy were alive and disease-free. The study also found that having radiation therapy after a SL didn’t prevent the cancer from coming back again.

Overall, the study concluded that, while SL was associated with a slightly higher chance of the cancer returning, it didn’t result in worse overall outcomes for patients. Therefore, SL could be a good option for patients who wish to delay or avoid a mastectomy. The researchers suggest that both options should be discussed with patients before making a surgical decision.

FAQs

  1. What is a salvage lumpectomy (SL) and how does it differ from a mastectomy?
  2. What were the main findings of the study regarding the recurrence of cancer in patients who underwent a salvage lumpectomy (SL) versus a mastectomy?
  3. What factors should be considered when choosing between a salvage lumpectomy (SL) and a mastectomy for breast cancer treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumpectomy is to discuss the possibility of having radiation therapy after the procedure to help reduce the risk of the cancer returning. It’s important to have an open and honest conversation with your healthcare provider about all of your treatment options and the potential risks and benefits of each. Ultimately, the decision should be based on your individual preferences and medical history.

Suitable For

Patients who are typically recommended lumpectomy are those who have early-stage breast cancer and want to preserve as much of their breast tissue as possible. Lumpectomy is often recommended for patients with small tumors that have not spread to the lymph nodes or other parts of the body. Additionally, lumpectomy may be recommended for patients who are not good candidates for mastectomy due to other health conditions or personal preferences.

In the case of salvage lumpectomy, it may be recommended for patients who have experienced a recurrence of breast cancer following initial treatment with lumpectomy and radiation therapy. Salvage lumpectomy allows for the removal of the tumor while preserving the rest of the breast tissue.

It is important for patients to discuss their treatment options with their healthcare team, taking into consideration their individual medical history, preferences, and goals for treatment. Ultimately, the decision between lumpectomy and mastectomy should be made based on a thorough discussion of the risks and benefits of each option.

Timeline

Timeline of a patient’s experience before and after lumpectomy:

Before lumpectomy:

  1. Diagnosis of breast cancer through mammogram, ultrasound, or biopsy.
  2. Consultation with oncologist and breast surgeon to discuss treatment options.
  3. Decision to undergo lumpectomy as part of breast-conserving therapy.
  4. Pre-operative tests and preparations for surgery.
  5. Lumpectomy surgery to remove the tumor and surrounding tissue.

After lumpectomy:

  1. Recovery period, which may include pain, swelling, and limited arm movement.
  2. Pathology report to determine if the tumor was completely removed.
  3. Follow-up appointments with oncologist and surgeon to discuss further treatment options.
  4. Radiation therapy, if recommended, to target any remaining cancer cells.
  5. Monitoring for recurrence through regular mammograms and check-ups.
  6. Long-term survivorship care to address any physical or emotional side effects of treatment.
  7. Consideration of salvage lumpectomy or mastectomy if cancer recurs in the same breast.

Overall, the patient may experience a range of emotions and physical challenges throughout the treatment journey, but with proper care and support, they can achieve positive outcomes and quality of life after lumpectomy.

What to Ask Your Doctor

  1. What are the benefits and risks of undergoing a salvage lumpectomy compared to a mastectomy?
  2. How likely is it for the cancer to come back after a salvage lumpectomy compared to a mastectomy?
  3. Will I need radiation therapy after a salvage lumpectomy, and how effective is it in preventing the cancer from returning?
  4. How will a salvage lumpectomy impact my overall quality of life and recovery compared to a mastectomy?
  5. Are there any specific factors about my individual case that make me a better candidate for one surgical option over the other?
  6. What are the long-term outcomes and survival rates associated with salvage lumpectomy versus mastectomy based on my specific situation?
  7. Are there any alternative treatment options or clinical trials that I should consider before making a decision about surgery?
  8. How experienced is the surgical team in performing salvage lumpectomies, and what is their success rate with this procedure?
  9. What is the post-operative care and follow-up plan after undergoing a salvage lumpectomy, and how will it differ from a mastectomy?
  10. Can you provide me with any additional resources or information to help me make an informed decision about choosing between salvage lumpectomy and mastectomy for my breast cancer recurrence?

Reference

Authors: Sellam Y, Shahadi ID, Gelernter I, Zippel D, Sklair-Levy M, Symon Z, Galper S, Ben-David MA. Journal: Breast J. 2019 Jul;25(4):619-624. doi: 10.1111/tbj.13290. Epub 2019 May 13. PMID: 31087430