COMMON QUESTIONS ABOUT BREAST CANCER: WHAT KIND OF SURGERY SHOULD I HAVE?

The type of surgical procedure performed is generally based on the stage of breast cancer noted at diagnosis (table 1). For women who have stage 0 breast cancer, which is confined to the lobules or the ducts, some doctors recommend a total mastectomy. Some physicians will bypass removal of the lymph nodes of the armpit; others prefer to remove them to make certain the cancer does not spread. For women with larger breasts, the doctor may suggest a lumpectomy or a partial mastectomy, followed by radiation therapy. You should be aware that there is a small but statistically significant difference in the rate of cancer recurrence. The cure rate following a simple mastectomy is essentially 100 percent, whereas the rate of cancer recurrence has been shown to increase about 1 percent each year after a lumpectomy with radiation.

For women with stage I or II breast cancer, the rate of cure following a simple mastectomy is not 100 percent; it has been shown to be approximately equivalent to the rate subsequent to the less extensive surgical procedures. Many doctors therefore suggest a lumpectomy or partial mastectomy in these instances. Still, a doctor may recommend a simple mastectomy to some patients—those, for instance, with multiple tumors, a large tumor, tumors that have spread to the lymph nodes, or tumors that involve the center of the breast.

In stages III and IV breast cancer the tumor is generally much larger and may require chemotherapy to shrink it prior to surgery. After the tumor has responded to treatment, surgery is performed to remove as much as possible of the remaining tumor in the breast. The operation may be a modified radical mastectomy or, in some cases where the tumor has spread to other parts of the body, a lumpectomy may be performed.

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Cancer