Breast Conservation Therapy - Conserve and Preserve the Breast
Surgery is very important for breast cancer. It is usually the first treatment for breast cancer, with radiation therapy or drug therapy added afterwards in some patients. For many decades, only one operation was available: mastectomy.
Mastectomyis complete surgical removal of the breast. This worked quite well in eliminating the cancer, but is disfiguring; the breast is removed and a long scar runs across the woman's chest in its place. Some doctors thought this was over-treatment for small breast cancers and they experimented with a technique called lumpectomy.
Lumpectomy is a much simpler procedure, which removes only the cancerous lump itself; much less of the normal breast is removed, and the breast often looks almost normal after the procedure except for a small scar. Other descriptions for lumpectomy include partial mastectomy, segmental mastectomy, and tylectomy. These words all mean essentially the same thing as lumpectomy. Several trials (experiments) were done comparing lumpectomy to mastectomy. Lumpectomy by itself did not work well because more than one-third of cancers grew back in the breast around the lumpectomy area. This is called a local recurrence because the cancer recurs in the part of the breast where the original cancer first appeared.
Why did some of these cancers re-grow in the breast? The reason is that lumpectomy left behind invisibly small amounts of cancer. Cancers do not grow as smooth round balls. Cancers can have long tiny tendrils that stretch away from the visible lump. When the surgeon removes the lump, he or she cannot see these invisibly small pieces of cancer which may be left behind. This invisibly small residual cancer would grow back over the next few years and cause a local recurrence. The only way to surgically remove these small amounts of residual cancer after lumpectomy is to do a mastectomy.
Because of this problem with local recurrence doctors concluded that lumpectomy alone was not enough. Around this same time, radiation therapy became widely available and doctors learned that radiation was effective in safely eliminating small amounts of cancer from the body. Doctors then tested whether radiation could eliminate the small amounts of cancer left in the breast after lumpectomy.
Many very large trials (experiments) were performed worldwide. These trials proved that the combination of lumpectomy and radiation was just as effective as mastectomy for early breast cancer; the cure rate was the same for women undergoing lumpectomy and radiation as it was for those choosing initial mastectomy.
This combination of lumpectomy and radiation is often referred to as breast conservation because it effectively treats the cancer, but permits a woman to preserve her breast.
Our physicians were early strong advocates for breast conservation therapy. In St. Louis, Dr. Kuske was a leader in elevating the breast conservation rates from a mere 15% to over 50% during his 7-year tenure at Washington University and Barnes Hospital. In Phoenix, Dr. Quiet and her surgical colleagues wiped-out the national reputation of the Valley as being the "bilateral mastectomy capitol of the world." In the 1980s and early 1990s, the standard treatment included whole breast radiation, many times with an extra radiation dose to the site at greatest risk for recurrence to the lumpectomy site. Because a large volume of tissue was included in the radiation field, a light dose of radiation was delivered daily, allowing normal tissues to repair after each dose. The typical regimen lasted 6-7 weeks, and the cumulative dose was enough to eliminate cancer cells in the breast.
Even when you need conventional raditaion, who you go to matters!