Save your breast!
YOUNG women with early-stage breast cancer face a really difficult decision: how much to cut?
Do you remove the entire breast and have more peace of mind that all the cancer has been removed, but have to live without an essential physical part of your womanhood for the rest of your life?
Or do you remove just the cancerous part and conserve as much of the breast as possible, but perhaps worry a bit more about cancer recurrence?
Such patients have the option to undergo breast-conserving surgery, which is an operation where the cancer is removed while leaving as much normal breast as possible.
While breast-conserving surgery allows women to keep most of their breast intact, it must be followed by radiotherapy.
Mastectomy, on the other hand, involves removal of the entire breast.
Most often, patients with early stage breast cancer undergoing mastectomy will not require radiotherapy, unless they have some special indications.
Although young breast cancer patients have conventionally been more likely to undergo breastconserving surgery compared to mastectomy, there are two things that may influence their decision to opt for mastectomy.
These are the irrational fear and unsubstantiated concerns on the safety of adjuvant radiotherapy, and the misconception that mastectomy offers a survival advantage compared to breast-conserving surgery.
Notably, the rates of mastectomy among Asian women with early breast cancer have been traditionally very high.
Similar survival rate
In our study published online in the journal BJS Open, we had examined the trends in surgical management of young women with earlystage (stage I or stage II) breast cancer in an Asian setting across four tertiary referral centres located in Kuala Lumpur, Singapore and Hong Kong.
The survival outcomes between young breast cancer patients treated with breast-conserving surgery and mastectomy were compared.
It was found that a majority of young patients with early stage breast cancer in this study had received mastectomy (64%). This was almost double the reported mastectomy rates in the United States and Europe.
Furthermore, over a 15-year period, only a modest increase in rates of breast-conserving surgery was observed.
Importantly, this study showed that five-year survival was 95% in these young early-stage breast cancer patients undergoing breast conservation, compared to 93% in their counterparts who underwent mastectomy.
The results remained unchanged even after differences in patient, tumour and treatment characteristics were taken into consideration.
This finding is in line with results from previous research conducted in Western settings, hence strengthening the evidence that the survival rates following breast-conserving surgery and mastectomy in young women with early breast cancer are not very different.
The current study findings that breast-conserving surgery at the least, confers equivalent survival gains as mastectomy should come as good news to young Asian women with early breast cancer.
It is hoped that with this Asian study, young patients newly diagnosed with breast cancer are more confident in making decisions on the type of surgery that they would like to have.
We would also like to emphasise that prior studies, including those conducted in Asian settings, have shown that breast-conserving surgery is associated with many other advantages, including maintaining or restoring quality of life, preserving self-image, and positively impacting sexuality.