Choice between lumpectomy, mastectomy requires patient-provider collaboration

The decision to undergo either a mastectomy or a lumpectomy is an incredibly personal decision that the majority of patients with breast cancer will have to face during treatment, Susan K. Boolbol, MD, chief of the Appel-Venet Comprehensive Breast Service at Mount Sinai Beth Israel, told HemOnc Today.

“The reality is – and it’s really good – that in our country, most breast cancers are diagnosed early – meaning smaller – and patients do have the option between a lumpectomy and a mastectomy,” she said.

Susan K. Boolbol

However, Boolbol acknowledged that there are instances in which patients don’t have the option to decide and must undergo a mastectomy.

“This is usually based on the size of the breast cancer compared with the size of their breast,” she said.

The positive, Boolbol mentions, is that the type of surgery does not impact overall survival rates. Instead, survival is dictated on the biology of the cancer and the course of the disease.

“Women will take all sorts of important factors into play when making this decision,” she said. “Some of it is based on their family history and their personal experience with breast cancer, and to be honest, that’s really what it comes down to.”

Patients who have had negative personal experiences with the disease are more likely to undergo a mastectomy – or even a bilateral mastectomy – and patients who have witnessed positive outcomes are likely to be more optimistic about the disease and are often inclined to undergo a lumpectomy, she said.

While the patient is ultimately the one who decides which procedure to undergo, it is equally important for physicians to “understand the power that they have in guiding that decision.”

“It’s really important for patients to understand that whether or not they need chemotherapy has nothing to do with the type of surgery that they undergo,” she said. “I hear that every day in my office, where a woman will say, ‘Well I’ll just have a mastectomy and that way I won’t need chemotherapy,’ and I try to explain the difference to them between local treatment and systemic treatment and that’s a really important point.”

Another important factor for patients to consider is if they have a genetic mutation that greatly predisposes them to future occurrences.

Women who have a genetic mutation are generally more likely to undergo a mastectomy and even elect to have both breasts removed, she said.

In the end, it is important for patients and physicians to work together during the process to determine which option is best.

“Women – and men who have breast cancer – will make the best decision for them when we as physicians give them the information that they need to make those decisions and that really is a critical part of our job,” she said. – by Ryan McDonald

Disclosure: Boolbol reports no relevant financial disclosures.