Surgical options for breast cancer

By Troy F. Kimsey, MD, FACS; Surgical Oncologist

WEB-Kimsey_Troy-MD-2014_1When it comes to breast cancer, we generally treat the whole breast. We either do a mastectomy (in which the whole breast is removed) or breast conservation (where the mass is removed and the remainder of the breast undergoes radiation treatment).

With a lumpectomy, some type of radiation is always required. For low-risk tumors, Kimsey says, radiation can be applied specifically to the lumpectomy site with fewer side effects than standard radiation.

There is no significant difference in survival between women who choose a mastectomy versus breast conservation.  They’ve looked at this comparison extensively in thousands of women and have never demonstrated a difference in overall survival rates between women undergoing mastectomy versus breast conservation. There’s a slightly higher risk of recurrence recurrence with breast conservation, but it doesn’t translate into a greater survival advantage.

Women who have a lumpectomy must also have radiation, and that’s not always possible for some patients, either for health or logistical reasons.  Some women can’t come to radiation five days a week for six to seven weeks. There’s also a population of women that really desire to have everything removed, and they aren’t particularly focused on conserving their breast. They’ll usually opt for mastectomy.

The decision to do chemotherapy depends on the type of tumor and whether it has spread outside of the breast, for example to the lymph nodes in the axilla, or armpit.
Historically, we removed all of the axillary lymph nodes in women with breast cancer, but in the last 15 years or so, a technique called ‘sentinel’lymph node biopsy has been developed. This tests the first lymph nodes in the axillary chain. If these are negative, we don’t remove the other lymph nodes.

In the future, breast cancer treatment will involve a more thorough understanding of each type of tumor and the type or treatment to which it will respond.  I think the future of breast cancer treatment will involve an understanding of the biology of each particular breast cancer including the genetic profile and receptor status of each tumor, and tailoring the treatment to that particular breast cancer.

Of course, I must stress that that good breast cancer treatment begins with screening. The thing that’s made the greatest impact on outcomes in breast cancer is screening. The earlier we detect breast cancer, the better patients do.  We recommend yearly mammograms starting for most women at age 40. If a woman has a family history of breast cancer, she should start screenings 10 years before the age of their diagnosis.

Troy F. Kimsey, MD, FACS, is a surgical oncologist with Premier Surgical Associates at Fort Sanders Regional Medical Center.

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