Whole Breast Radiation
Results Without Radiation Therapy
Why can't I have just a
lumpectomyfor my breast cancer? Why is radiation therapy recommended?
Surgery and radiation work together to cure cancer in the breast. The lumpectomy procedure is surgical removal of the cancerous lump. The amount of breast tissue removed can be as small as a golf ball, or as large as an orange; every situation is different. Radiation therapy is usually given four to six weeks after lumpectomy, after all the surgical wounds have healed. Very few patients have a local recurrence after lumpectomy and radiation, and the very small percentage of patients who do have a local recurrence after lumpectomy and radiation may still have a mastectomy and be cured of their cancer. The result is that the cure rate for women choosing breast conservation is the same as for women undergoing mastectomy. And for this reason, most women with early breast cancer have the option of breast conservation in addition to the old standard of mastectomy.
Illustration: Invisibly small amounts of cancer can be left behind after lumpectomy. Radiation therapy can successfully eliminate these deposits.
It is important that all visible cancer be removed by the surgery, because large amounts of cancer cannot always be eliminated by radiation therapy. That's why we sometimes describe breast conservation as surgery for the "big piece," and radiation for the "little pieces." Once in awhile, a patient needs a second lumpectomy to remove remaining visible cancer - a big piece - which is left behind after the first lumpectomy. Breast conservation is still very safe and effective if all the visible cancer can be removed in this second surgery. Rarely, large amounts of cancer remain despite a second lumpectomy procedure, and the patient usually has a mastectomy because breast conservation is less effective in this situation.
Some patients with
early breast cancer still choose mastectomyeven if they could have breast conservation. Rushing to mastectomy is often the first impulse a woman feels after discovering she has breast cancer, and that reaction is understandable. But, it is important that a patient hear all of her options before making a decision about treatment. In fact, it is the obligation of her
cancer doctorsto provide her with this information and, moreover, to make this information understandable before she makes her decision. Every patient is unique. Some will choose mastectomy for the smallest cancer even if breast conservation is possible, and this is perfectly fine, as long as the patient understands all of her options. Other patients will go to any length to conserve their breast and avoid mastectomy.
Women who choose to have a mastectomy rather than breast preservation usually do not need radiation after the mastectomy.The exception is a woman whose cancer is unexpectedly larger at the time of surgery or if many lymph nodes have cancer in them. In these patients,
radiation may be used to treat the chest and lymph noderegions (the armpit and area behind the collarbone) because radiation therapy lowers the chance of the cancer coming back in this area and improves her chances of surviving the breast cancer. This type of radiation is called post-mastectomy (meaning after mastectomy) radiation.
Results With Radiation Therapy
What are the chances of the cancer recurring in my breast if I choose breast conservation with lumpectomy and radiation?
Recurrence of cancer in the breast is around 5% after lumpectomy and radiation. This is much less than the one-in-three recurrence rate seen after lumpectomy only. And this is about the same recurrence seen with mastectomy, which is also well under 10%.
FOOTNOTE: In fact, this number - the one in three patients who recur if they undergo only lumpectomy - might be smaller or larger, depending on the size the cancer, the age of the patient, and other features. In some very specific situations, the risk of recurrence might be higher, perhaps as high as 40%.
In other situations, the risk is quite small with lumpectomy alone; some recent information identified patients with less than a 10% risk of recurrence after lumpectomy alone - provided that the patients took an estrogen-blocking drug like tamoxifen afterwards. But as we discuss below, radiation will decrease the risk of recurrence for all patients and reduce the risk of local recurrence. Most doctors still recommend radiation be used after lumpectomy for patients with breast cancer.