“From what I’d heard about mastectomy, I knew that it was a very invasive surgery and difficult to go through,” says Kate, who lives in New Jersey and works in finance. “Unless it was the only option for lowering my chance of cancer recurrence, it’s not something that I would want to do.”
Kate chose a lumpectomy, as are an increasing number of patients with breast cancer, according to a recent study from Memorial Sloan Kettering Cancer Center (MSK). After many years in which the rates of mastectomy rose while lumpectomy rates went down, the trend has started to reverse, the research found. MSK experts say this development is promising because when patients choose to have less extensive surgeries, it lowers their risk of complications without compromising their prognosis.
“When trends previously were going in the direction of patients choosing more invasive procedures, it was counterintuitive for medical providers,” says MSK plastic and reconstructive surgeon Jonas Nelson, first author of the paper published June 8, 2022, in JAMA Surgery. “Our current data suggests a shift back toward less invasive surgical modalities for breast cancer treatment.”
When To Consider a Mastectomy
For patients with a high risk of developing a second tumor, such as those with inherited mutations in BRCA or other genes, mastectomy (the complete removal of one or both breasts) may be the best choice.
When To Consider a Lumpectomy
But for patients with average risk of developing a second cancer, lumpectomy (removal of only the tumor and a small amount of surrounding tissue) has been shown to be as effective as mastectomy for long-term survival when it’s used in combination with radiation therapy as part of a breast-conserving surgical approach.
MSK Doctors Match People With Breast Cancer to the Best Surgical Treatment
“More than a decade ago, we started to realize that despite what we knew about the safety and effectiveness of lumpectomy, the rates of both single and double mastectomy were going up,” says MSK plastic and reconstructive surgeon Evan Matros, senior author of the JAMA Surgery study. “That was a wake-up call for doctors. It suggested we needed to do a better job of educating our patients about the risks and benefits of their surgical options.”
Doctors at MSK have played an important role in sounding the alarm about the increase in patients choosing to have more invasive surgeries for breast cancer. It’s part of a larger movement to get out the message that more treatment is not always better treatment. This principle can be applied to other cancers, too. Active surveillance may be recommended for some cancers of the prostate and thyroid. Lower doses of radiation can be used to treat certain patients with head and neck cancers. As cancer care advances, it’s possible to achieve good results and minimize toxic side effects.
“For patients with breast cancer, our care team at MSK really looks at the risk for each individual to help them avoid any unnecessary treatments,” Dr. Nelson says. “This goes beyond just surgery, by also looking at which patients may or may not benefit from chemotherapy or radiation, for example.”
Why Kate Followed Her Doctor’s Recommendation for a Lumpectomy
Kate was diagnosed with breast cancer in September 2020, shortly after having her first mammogram at age 47. “I’d never been concerned about my health, and I didn’t even have a primary care provider,” says Kate, a former college lacrosse player who says she’s always been fit. But after the COVID-19 pandemic began, she decided to find a doctor to conduct a thorough checkup.
When her mammogram revealed a tumor, a friend recommended she go to MSK, where she met with breast surgeon Hiram Cody III. “At my first appointment, Dr. Cody told me that mastectomy was something we could talk about, but that he recommended a lumpectomy because of the size and placement of my tumor,” Kate says. “As an ex-athlete, I thought of this cancer the same way I would an injury: I should follow the doctor’s recommendations if I wanted to get better.”
Patients Often Report Higher Satisfaction With Lumpectomy Versus Mastectomy
The JAMA Surgery study analyzed more than 3.4 million breast cancer patients who had surgery between 2005 and 2017. The investigators discovered a shift in 2013. Between 2005 and 2013, lumpectomies were decreasing while mastectomies rose. After 2013, the trend began to reverse.
The researchers attribute this shift to many factors. Patients’ surgical preferences can be influenced by the way doctors frame the risk of developing a future cancer, as well as how they describe the potential complications after surgery, according to another study from Dr. Matros, published in the Journal of the American College of Surgeons in November 2021.
A patient-reported outcome tool developed by MSK, called the Breast Q®, asks patients about their satisfaction and quality of life both before and after surgery. It has revealed that patient satisfaction can be higher for those who maintain their breasts by having a lumpectomy. Dr. Matros also notes that a newer reconstructive surgery called oncoplastic rearrangement can help minimize the deformities that sometimes result from lumpectomy, making patients happier with their appearance after cancer surgery.
‘I’m Absolutely Happy With My Decision’
Because of the location of Kate’s tumor, she chose not to have reconstructive surgery on her affected breast. But she decided to meet with Dr. Nelson to discuss the possibility of having cosmetic surgery on her healthy breast to make them more symmetrical. So far, she hasn’t felt the need. This surgery is still an option if she changes her mind.
“Overall, I would say I’m absolutely happy with my decision. I consider myself very lucky,” Kate says. “I would not do anything differently if I had to make the same decision all over again.”