Breast Conservation: Save the Tatas!

By Elizabeth Falkenberg, M.D., radiation oncologist at Alliance Cancer Care

Women who are diagnosed with breast cancer have choices.  In fact, most women are diagnosed in the early stages of cancer because of a yearly mammogram.  Still, a new diagnosis of cancer can be scary and confusing.  Many family and friends offer well-meaning advice, but your medical team is here to provide research-based recommendations for your treatment.  Breast cancer is treated as a multi-disciplinary approach where the patient can meet with a breast surgeon, medical oncologist, and radiation oncologist before starting any cancer treatments.  Your physicians can explain an overall “game plan” so you know what to expect.

Many patients come to their first visit thinking, “Take both breasts off, so I will live longer.”  This is a MYTH!  If this were true, medical professionals would never offer a “lumpectomy” or breast-conserving surgery (BCS) as an option. In fact, breast-conserving surgery is the preferred option for early-stage breast cancer in the National Comprehensive Network Guidelines.  BCS is removing the breast tumor with a small margin of normal tissue around it, so there are no tumor cells at the edge.  Multiple randomized trials have proven women with breast cancer will NOT live longer by having a bigger surgery.  Many people think that removing the breasts will remove the chance that cancer can return; but unfortunately, cancer can still return after a mastectomy.  Cancer can recur under the skin in the mastectomy area, in the lymph nodes, or in other areas of the body.  The risk of the cancer returning is based on multiple other risk factors, not the amount of surgery.  Patients who choose to have BCS will have radiation therapy to the breast and possibly the lymph nodes.

Many women cannot have breast-conserving surgery because their tumor is too large or in multiple areas of the breast.  These women must have a mastectomy because removing the cancer with a margin would remove almost all of the breast tissue.  Some women (5-10%) have a genetic disposition for breast cancer.  These women may be recommended to have a mastectomy because their risk of having a second cancer can be reduced by having a mastectomy.  This is something that should be discussed in detail with your doctor.  Some women have lymph nodes involved with cancer and will require more chemotherapy or radiotherapy even after a mastectomy, but it is good to discuss this with your physician ahead of time to have a clear understanding of your expectations, along with the oncologist’s treatment plan.

So remember to get your yearly mammogram, to increase any chance of finding cancer when they are small and still curable.  Ask your physicians about treatment options and a multidisciplinary approach.  Most women are candidates for a lumpectomy followed by radiation therapy to the breast, with or without chemotherapy.  We want YOU to have the optimal treatment, and ask questions that YOU want to be answered!