Nicole Snyder of Goose Creek, South Carolina, is in treatment for early-stage breast cancer. Her doctors recommended breast-conserving surgery. She chose a double mastectomy instead.
Years earlier, Snyder’s mother had a lumpectomy. After 13 years, cancer was found in her other breast. It spread and ultimately took her life.
“When you have a family member who has died from breast cancer, you live waiting for that shoe to drop,” Snyder told Healthline. “Opting for lumpectomy, I would have simply extended that feeling. Now, I really feel like I have a chance that this disease will no longer haunt me.”
For women with early-stage breast cancer, choosing between breast-conserving surgery and mastectomy can be complicated. But researchers now say women who choose breast-conserving therapy (BCT) plus radiation therapy have better survival rates after 10 years.
New Study, New Information
Previous randomized controlled trials showed that the long-term survival rate for BCT is about the same as for mastectomy without radiation.
But most of those were five-year studies. That’s why researchers in the Netherlands conducted a 10-year follow-up.
“Since recurrences are described to occur after five years as well, getting more insight into the long-term outcomes after different types of surgery based on daily practice experience on a national level is of great importance," Sabine Siesling, Ph.D., said in a press release.
Siesling is senior researcher at the Netherlands Comprehensive Cancer Organisation.
According to data presented at the 2015 San Antonio Breast Cancer Symposium, women with early stage breast cancer actually have better long-term outcomes with BCT than with mastectomy alone.
The researchers used data from the Netherlands Cancer Registry. Included were 37,207 women who had early stage breast cancer between 2000 and 2004. This group was used to estimate 10-year overall survival. About 58 percent of them had BCT. The rest had mastectomies.
They included a subgroup of 7,552 patients who were diagnosed in 2003. This group was used to estimate 10-year disease-free survival. About 62 percent had BCT. The rest had mastectomies.
Women in the BCT group were about 21 percent more likely to be alive after 10 years. They also had fewer local recurrences and distant metastases.
It’s worth noting that patients in this study who received BCT tended to be younger than the mastectomy patients. They also had more favorable tumor characteristics. Siesling says her research methods corrected for these factors. Still, they can’t be completely ruled out.
Study authors concluded that radiation therapy might be better for overall survival because it kills cancer cells left after surgery.
Complications and Costs
Another study presented at the symposium looked at complications and costs.
Patients who had mastectomy plus breast reconstruction had the highest complication rate, and the highest costs because of complications.
“What we show for the first time is that while the patient is undergoing more surgery, she is also taking on a considerable amount of risk with regard to what could happen,” Dr. Benjamin D. Smith said in a press release.
Smith is associate professor and research director at the Department of Radiation Oncology at the University of Texas MD Anderson Cancer Center. He said that mastectomy is still the best option for some early breast cancer patients.
Dr. Michaela L. Tsai specializes in breast oncology at Piper Breast Center at Abbott Northwestern Hospital in Minnesota. She told Healthline that when comparing the two surgeries, a mastectomy is much more significant. Even more so if you add reconstruction. It requires more time under anesthesia, more time in the hospital, and a longer recovery time.
“Complications such as bleeding, infection, and pain are much more likely with the bigger surgery,” said Tsai.
Benefits and Risks of Surgeries
Tsai said many women think mastectomy will improve their chances of survival or help them avoid additional treatments.
“This is really not true for most women,” said Tsai. “Whether a woman has a lumpectomy with radiation or mastectomy has no impact on the development of systemic disease. The tumor biology and the tumor stage determine this. Systemic therapy is what prevents this.”
Tsai fears too many women choose mastectomy for peace of mind.
“This is perhaps falsely reassuring, as mastectomy and reconstruction does not prevent systemic recurrence, which is what one should truly be most concerned about,” she said.
Sometimes, it’s the doctors who push for mastectomy. When 54-year-old Lisa Tsering of El Cerrito, California, was diagnosed, doctors wanted to perform a mastectomy.
“Luckily, I got a second opinion and ended up with a mere lumpectomy and radiation,” Tsering told Healthline. “That was three years ago and I remain cancer free.”
For most early stage breast cancer patients, Tsai recommends BCT. She believes it’s reasonable to choose mastectomy in some cases, though. For BRCA mutation carriers, there’s a proven survival benefit of bilateral mastectomy over BCT.
Another reason would be if tumors were hard to see on imaging tests. Also, for some women, radiation treatment might pose a hardship.
There are no guarantees either way. Nicole Snyder’s mother had radiation and chemotherapy after her lumpectomy.
Nicole tested negative for the BRCA mutation. She has had complications from reconstructive surgery, but is pleased with the result – and her decision.