Our Summary

This research paper discusses the safety and survival rates of breast-conserving surgery, like lumpectomy, compared to mastectomy, which is the removal of the entire breast. Adjuvant radiation is usually recommended after a lumpectomy to lower the risk of cancer recurrence. Comprehensive breast imaging is essential to check for potential cancer in the other breast and to understand the extent of the disease, which helps determine if a patient is suitable for a lumpectomy.

The use of MRI in this context is still debatable, as it increases the rates of mastectomy without clear evidence of improving local control of the disease. Ongoing studies aim to clarify the role of MRI in newly diagnosed breast cancer.

The paper also discusses a consensus in the oncology community that no traces of cancer should be left after a lumpectomy. Post-lumpectomy imaging might be needed to confirm the complete removal of cancer, and there may be cases where further surgery is necessary if the margins are too close.

Lastly, the paper notes that more people in the U.S. are choosing to have a preventative mastectomy on the non-cancerous breast. However, patients must be informed that this does not improve survival rates, can have more complications, and while it reduces risk, it does not completely eliminate it.

FAQs

  1. Is lumpectomy as safe and effective as mastectomy in treating breast cancer?
  2. Why is adjuvant radiation recommended following lumpectomy surgery?
  3. What is the role of MRI in determining eligibility for breast conservation surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumpectomy is to ensure they undergo post-lumpectomy imaging to confirm complete removal of all cancer-associated microcalcifications. This can help ensure that all cancerous cells have been successfully removed during the surgery. Additionally, it is important for patients to understand the importance of adjuvant radiation therapy following lumpectomy to minimize the risk of local recurrence. Regular follow-up appointments with their healthcare team are also crucial to monitor their recovery and overall health.

Suitable For

Patients with early-stage breast cancer, typically stage 0-2, are typically recommended for lumpectomy. This includes patients with small tumors that can be easily removed with clear margins, as well as those with tumors that are not located close to the chest wall or skin. Patients who are medically fit for surgery and able to tolerate adjuvant radiation therapy are also good candidates for lumpectomy. Additionally, patients who have a strong desire to preserve their breast and have realistic expectations about the outcome of the surgery may also be recommended for lumpectomy.

Timeline

  • Before lumpectomy:
  1. Patient undergoes imaging tests such as mammography, ultrasound, and potentially MRI to determine the extent of the disease and assess eligibility for lumpectomy.
  2. Comprehensive clinical examination is conducted to evaluate the patient’s overall health and suitability for surgery.
  3. The patient discusses treatment options with their healthcare team, including the potential benefits and risks of lumpectomy versus other surgical options.
  4. Pre-operative preparations are made, including discussions about anesthesia, post-operative care, and potential complications.
  • After lumpectomy:
  1. Patient undergoes post-operative monitoring and receives instructions for wound care and pain management.
  2. Adjuvant radiation therapy is typically recommended to reduce the risk of local recurrence.
  3. Follow-up appointments are scheduled to monitor healing, assess for any signs of infection or complications, and discuss further treatment options if necessary.
  4. Patients may undergo additional imaging tests to confirm complete removal of cancerous tissue and evaluate the need for further surgery or adjuvant therapy.
  5. Long-term follow-up care is provided to monitor for any signs of recurrence and address any physical or emotional concerns related to the surgery and treatment.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing a lumpectomy compared to a mastectomy?
  2. How will the decision to undergo a lumpectomy affect my long-term prognosis and survival?
  3. Will I need adjuvant radiation therapy following the lumpectomy, and what are the potential side effects of this treatment?
  4. What imaging tests will be necessary before and after the lumpectomy to ensure the complete removal of cancerous tissue?
  5. Are there any alternative treatment options to consider besides lumpectomy?
  6. What is the likelihood of needing a second surgery (re-excision) if the margins are found to be close after the initial lumpectomy?
  7. How will the lumpectomy affect the appearance and function of my breast?
  8. What is the recovery process like after a lumpectomy, and how soon can I expect to return to my normal activities?
  9. Are there any specific lifestyle changes or follow-up care that I should be aware of after undergoing a lumpectomy?
  10. What are the potential risks and benefits of undergoing contralateral prophylactic mastectomy in addition to the lumpectomy, and how will this decision impact my overall treatment plan and outcomes?

Reference

Authors: Newman LA. Journal: Oncology (Williston Park). 2017 May 15;31(5):359-68. PMID: 28512732