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Q. "Why would any woman pick mastectomy if the survival rate is the same?"
A. Thanks to early detection, between 70 and 75 percent of women diagnosed with breast cancer today are possible candidates for lumpectomy or other breast-conserving surgery. Yet, half of these women undergo mastectomies instead. Some of those women are making a well-informed choice. Some do not know that they have a choice. And, because of the costs of health care, some cannot afford to make the choice they would prefer.
Unfortunately, cost sometimes prevents women from choosing breast-conserving surgery. Lumpectomy followed by radiation costs more in the short term than mastectomy, and some insurance plans do not cover all the expenses of the lumpectomy or the radiation therapy. Reconstruction of the breast after mastectomy adds to the cost, but the law requires that insurance covers that expense. Despite the slightly higher cost of lumpectomy and radiation, that choice is actually less expensive if you look at costs for the five years after the initial diagnosis. Lumpectomy preserves the breast and there are few additional costs when the radiation treatment is completed, whereas breast reconstruction after a mastectomy may require several surgeries that add to the cost over time. This information may help women who are concerned about cost to decide what is best for them.
Another reason why women choose mastectomies is because they do not want to undergo radiation therapy or are unable to arrange radiation treatments. Radiation therapy is usually an outpatient procedure performed over a period of at least 5 weeks, and some women are not able to make that commitment. Some women live far away from radiation facilities, or can't afford to take the time for daily treatments. Others may have health conditions such as lupus or heart disease that prevent them from undergoing radiation. Since radiation reduces the chances of recurrence for women choosing lumpectomy, it is important that patients and their doctors consider the required time commitment to radiation therapy before deciding which surgical procedure is best for them.
Fear is another reason why some women choose mastectomy. Some women are afraid of radiation therapy. Radiation therapy does cause side effects, but they are usually mild -- like fatigue or skin irritation. Only very infrequently does radiation therapy induce more severe side effects.
Fear of recurrence of breast cancer is another reason why some women prefer a mastectomy to a lumpectomy. Some women assume that breast cancer won't return if the breast is removed. However, the cancer may return on the chest wall where the breast was removed because some breast tissue remains even following a mastectomy. For women who choose breast-conserving surgery with radiation, research clearly shows that radiation reduces recurrence for most women with early-stage breast cancer. The risk of cancer returning in the same breast is very low. After 12 years, only one out of approximately 10 women will have had a recurrence of cancer in the same breast. Most importantly, even if breast cancer does recur in the same breast, that does not reduce the woman's chances for a healthy recovery. However, a recurrence could require additional surgery, and a woman may decide to have a mastectomy at that time.
Many women want to make the surgical choice that will enable them to "get it over with and get on with my life." Many of these women choose mastectomies, in order to avoid the several weeks of radiation that is required for lumpectomy patients. However, even mastectomy patients may find that recovery takes longer than expected. Lymph nodes are removed with both lumpectomy and mastectomy, and the pain from arm swelling that can result may last a long time and be debilitating. If chosen, breast reconstruction after mastectomy often requires multiple additional surgeries and significant recovery time. Breast implant manufacturers have informed the FDA that one in four patients whose breasts were reconstructed with implants have at least one additional surgery within three years. For women undergoing TRAM flaps (a type of reconstructive surgery) and other reconstruction procedures, the pain from surgery can last for months.