Abstract | November 8, 2021
Choosing Mastectomy vs. Lumpectomy-with-Radiation: Experiences of Breast Cancer Survivors
Learning Objectives
- Discuss breast cancer surgical treatment and its impact on the women undergoing those procedures;
- Compare and contrast the difference between mastectomy vs. lumpectomy-with-radiation based on experiences of female breast cancer survivors;
- Provide breast cancer patients with information to help them make a more informed and individualized choice on breast cancer surgery.
Background: Annually about 280,000 women are diagnosed with breast cancer (BC). Treatment options depend on age, comorbidities, tumor stage, grade, size, and other factors. Often, patients must decide between two surgical treatment options: mastectomy or lumpectomy-with-radiation. Since these treatments offer similar survival outcomes, the choice ultimately depends on the patient. However, most rely on inputs from doctor, family, friends, personal research, and other actions. We believe decision-making processes for future patients could be aided if experiences of prior BC survivors were known. This study’s aim was to provide such information.
Methods: Feedback from prior BC survivors was obtained using a 20-question questionnaire distributed online to multiple BC support groups. It focused on issues relevant to choosing between the two surgical options including, post-surgical complications, breast reconstruction, chronic pain, BC reoccurrence, cosmetics, and surgery-choice satisfaction.
Results: Respondents (N=1205) had median age 49-years and BMI-26.5 Kg/m2 with 740 mastectomy patients (MP)and 465 lumpectomy-with-radiation patients (LP). Breast-reconstruction was 36.2% for MP and 13.5% for LP. Almost all (99.8%) LP had radiation side-effects; skin irritation and thickening and chest wall tenderness the most common. Among MP, 94.3% had ≥1 complication; loss-or-changes in nipple or breast sensation, uneven breasts, and breast swelling most common. Percentages of MP experiencing post-surgical pain ≥6 months (64.2%) was less than for LP (79.8%, p<0.00001), with 35.4% MP and 46.0% LP still in pain (p=0.0002). For 51.5% MP and 63.0% LP, cosmetic outcomes were satisfied or very satisfied while 16.1% MP and 7.5% LP were dissatisfied or very dissatisfied. Satisfaction of surgical treatment-choice was 84.7% for MP and 79.8% for LP.
Conclusion: There were significant differences between MP and LP responses. LP were more satisfied with cosmetic outcomes but reported skin thickening as a common radiation side-effect. Contrastingly, MP had less pain frequency. The composite data can aid future decision-choices.
