Early Stage Breast Cancer and Surgery Choices


Before 1990, the standard treatment for early stage breast cancer was a mastectomy, the removal of the entire breast.

 After 1990, as a result of a recommendation from the National Institutes of Health, many women with early stage breast cancer now had a surgical choice. Instead of a mastectomy, they could safely choose a lumpectomy, a surgery to remove the cancer and tissue surrounding the tumor, but not the entire breast.

A lumpectomy is usually followed by radiation treatments to reduce the risk of a recurrence in the breast or lymph nodes.

Both lumpectomy and mastectomy surgeries include removing lymph nodes under the arm to test for the presence of cancer cells.

The National Institutes of Health made their recommendation for offering lumpectomy as a safe alternative to mastectomy based upon the outcomes of many large, controlled trials that showed no difference between the 20-year survival rates of women who had lumpectomy and radiation or mastectomy.

As a result of the National Institutes of Health recommendation, mastectomy rates for women with early stage breast cancer went from 100% in the 1980s to less than 40% percent today. However, a recent study, published in the journal JAMA Surgery, found that the percentage of women with early-stage breast cancer opting for mastectomies is on the rise. Mastectomy rates have increased from 34 percent in 1998 to 38 percent in 2011.

Considerations for Both Surgeries

A lumpectomy can keep most of the appearance, as well as the sensation of the breast. Since it is a less invasive surgery, recovery time is shorter and easier than a mastectomy. 

Lumpectomy is not appropriate for some women.The size of a tumor, as well as the location of the tumor and the size of a breast, determine whether or not a lumpectomy is possible.

Another consideration in choosing lumpectomy over mastectomy is a time and travel commitment for treatment. Lumpectomy requires radiation treatments for a period of weeks. If a woman lives a distance from a treatment center, a lumpectomy may not be a realistic choice. Additionally, radiation is not an option for women with certain health conditions such as systemic lupus.

Mastectomy is a more extensive surgery than a lumpectomy and has a longer recovery period.

In 1999, I had a lumpectomy, followed by 36 radiation treatments. Pain was minimal; I returned to working within days. Radiation is painless.The cumulative effects of radiation took effect by day 15, and I began experiencing a marked loss of energy. I was able to work 5 out of my 6+ weeks in treatment. My energy level improved within days of completing treatment.

In 2009, for my second cancer, which was another primary in the opposite breast (not a recurrence of my first cancer), I chose a bilateral mastectomy. It didn’t make sense to keep the breast that once had a cancer.

After the first two days following surgery, pain was manageable with Tylenol. I was back working in a month.

Since both my cancers were early stage cancers, I didn’t need chemotherapy.

Final Thoughts

A woman’s decision to have a lumpectomy or a mastectomy is one that can be reached with the help of her breast surgeon after a thorough discussion of the pros and cons of each procedure, and her  concerns and preferences.

Jean Campbell is a 2x breast cancer survivor and the former founding director of the American Cancer Society New York City Patient Navigator Program in 14 public and private hospitals.She is executive director of a nonprofit organization providing research and resource information and support to women and men newly diagnosed with breast cancer.

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