Twenty years ago, nearly every woman who was diagnosed with breast cancer underwent mastectomy, often while under anesthesia for the biopsy itself with no participation in a discussion about treatment options. That should never happen today. Women do have options for managing this disease, and active participation in those choices can help women feel less victimized by the process.
Women (and surgeons) can be ambivalent about considering options short of mastectomy. “Is it really safe to do less than remove the whole breast if there is cancer in it?” is a common and sometimes unvoiced concern. This is an important question, and, thanks to two large clinical studies initiated by some brave and intelligent women and physicians back in the 1970s, we have an answer. These two large trials, one conducted in Europe and one conducted in the United States, randomly assigned women with breast cancer to treatment with either mastectomy or breast conserving surgery (also known as “lumpectomy”) coupled with breast radiation. These women were followed for the next 25 years to see if there was any survival advantage to either approach. There wasn’t. Women who underwent breast conserving therapy lived as long as their sisters who underwent mastectomy but obviously avoided the emotional and physical effects of losing their breast. Armed with this information, women who are newly diagnosed with breast cancer need to have a thorough discussion with their surgeons about whether breast conservation or mastectomy is right for them given the particular nature of their disease and circumstances.