ROBERT WAYNE, M.D., F.A.C.S.
2055 EXCHANGE STREET, STE. 190
ASTORIA, OR 97103
BREAST CANCER 2014 – CHOICES FOR PATIENTS
BY: ROBERT WAYNE, M.D., F.A.C.S.
In the past ten years there has been a major change in the way surgeons treat breast cancer. Prior to that time the only choice was radical mastectomy. Today we have choices ranging from radiation only, to limited surgery (lumpectomy), to modified mastectomy. The choice is one for both the patient and her surgeon to make. It revolves around the patient’s expectations and the surgeon’s determination for the best outcome. I will briefly explain each:
Radiation alone may be indicated for the very tiny tumor only found on mammography with little chance of distant spread. These tumors are usually not even able to be felt on examination of the patient. Essentially, biopsy is considered to have removed the tumor. The surrounding tissue is radiated to eliminate any residual cells that may still be existing locally. While results are promising for this mode of therapy, it does not appear to be as good as the two other choices to be examined. The benefits of avoiding surgery must be weighed against several weeks of daily x-ray therapy and occasional skin burns that result from high intensity radiation exposure.
Lumpectomy is considered conservative breast surgery. This technique requires wide excision of the section of breast where the tumor is located. This may require removal of as much as 25% of that breast. Two important considerations must be added to this wide local excision:
- The patient may require several weeks of radiation to eliminate any local tumor left behind.
- The patient may undergo axillary (armpit) sentinel lymph node biopsy.
It is when these two considerations are applied that the long term outlook for patient survival appears to be equal to modified or radical mastectomy.
Modified mastectomy (removal of the total breast and axillary glands) was the most widely accepted treatment of breast cancer in the United States. It has been eclipsed by the lumpectomy. Modified means the deformity required for chest wall muscle removal in the radical mastectomy has been eliminated. With this modification the stigmata of arm swelling and weakness has been markedly decreased. The deformity of the operation is considerably less. Finally, fitting for post-operative prosthesis is simpler and breast reconstruction after surgery is a more easily attainable goal. Again, the long term outlook for this modified procedure is equal to lumpectomy.
The choice is truly the patient’s, but remember, not all lesions will be amenable to radiation or lumpectomy. These choices, however, are something you and your surgeon can make together.