It’s a horrible choice to have to make.
Women with early stage breast cancer that hasn’t spread to the lymph nodes can often choose whether to simply have the tumor(s) extracted or have their entire breast removed. In recent years, there’s been a trend toward mastectomy, particularly among young women, because of improvements in breast reconstruction and better reimbursement from insurance companies. However, many doctors have decried this shift, pointing to research showing there is no survival benefit to a mastectomy when breast-conserving surgery (BCS) could have been used instead.
But a new study published in the journal European Society for Radiotherapy and Oncology (ESTRO) has found that younger women who opt for the more conservative surgery and radiation have a 13% higher local recurrence (such as a return of cancer in that breast or surrounding lymph nodes) over a 20 year period than those who have a mastectomy and no radiation. What’s unique about this study is that it looked at women younger than 45.
In the US, women who are 60 or older have the highest risk of developing breast cancer. But the disease progresses differently among the younger and older populations. As I’ve written before, breast cancer is typically more aggressive in younger women. And this new research bears that out: Women older than 45 who keep their breast are less likely to die than women under 45 who keep their breast instead of opting for mastectomy. The younger group has a higher risk of developing metastatic disease—meaning the cancer spreads to their bones or organs.
A massive study of women with breast cancer in 2014—more than 130,000—found that there was no survival benefit to having a mastectomy as opposed to having breast-conserving surgery. But, in that study, the median age for women who had BCS was 57, and for mastectomy, 62.
It’s important to remember that lumpectomies are still an effective form of treatment for many women, particularly due to improvements in radiation that follow the surgery. Philip Poortmans, the president of ESTRO, offered the following: “We have to view this from the right perspective though, as we have witnessed a remarkable decrease in the rate of local recurrences after BCT [breast-conserving therapy], even for young patients.”
That said, it’s a choice that no statistic or doctor can make for a woman diagnosed with breast cancer. Whether choosing breast-conserving surgery or mastectomy, a woman may face a lifetime of treatment, the threat of recurrence, and the specter of death.