Survival rates
always require reconstruction. That was a main reason Debbie Lacroix of Las Vegas was glad she had a lumpectomy plus radiation versus a mastectomy for her Stage 2 double-negative breast cancer.
“I just got through talking to somebody who wanted to take off her whole breast. I try to tell people, you know, it is their own decision but I chose to go with lumpectomy and it seemed to work for me,” Lacroix says. Four years later, she’s still cancer free.
Modern-day medicine
Technology is solving the challenges that lumpectomies initially presented.
In a traditional lumpectomy procedure, the surgeon removes the tumor, trying to ensure all the cancerous cells are gone by touch, sight or intraoperative X-ray devices. After the surgery, the tumor goes to a lab to be tested for clear margins, in other words, that cancerous tumor is completely surrounded by healthy cells. If the surgeon did not successfully remove all of the tumor, they have to re-operate, delaying the treatment process and radiation.
Medical devices such as Marginprobe, which has been available in the U.S. since 2015, can help surgeons identify and remove any cancerous tissue while the patient is still
A study published in 2014 in the Journal of the American Medical Association looked at the medical records of 189,734 California women who were diagnosed with early-stage breast cancer in one breast from 1998 to 2011.
Women had one of three procedures: lumpectomy with radiation (55 percent), single mastectomy (39 percent), double mastectomy (6 percent).
Researchers then looked at the 10-year survival rates of the three treatments groups and found what they reported to be no significant statistical difference:
■ 83 percent of women who had lumpectomy plus radiation were alive 10 years after diagnosis
■ 81 percent of women who had double mastectomy were alive 10 years after diagnosis
■ 80 of women who had single mastectomy were alive 10 years after diagnosis
asleep, reducing the chance that they would need to re-operate later. Both Holmes and Barber have adopted the device in their operating rooms.
“The patient would have to wait roughly a week, four to five days, before the physician can come back and tell them, ‘We got it all.’ So there’s a lot of anxiety that happens there, they don’t know, ‘Am I cancer free, am I not cancer free?’ ” says Lori Chmura, CEO of Marginprobe.
A relatively new drug called Pergeta, effective for Her2-positive breast cancer, can shrink tumors, after which surgeons can perform a lumpectomy.
But, Barber says, a tumor has to be tested for this gene to determine whether the patient is eligible for the drug, which can’t happen if the patient has opted for an automatic mastectomy. It’s about having more information and using that information to help women make informed decisions.
Ultimately, Holmes hopes that the decision to have a mastectomy is made with conscientious, realistic goals in mind. Undergoing a mastectomy, even in instances when a lumpectomy would be sufficient, can be appropriate if a patient wants to achieve symmetry between their breasts or eliminate the need for regular mammograms, which may cause considerable stress.
“The trend is driven by anxiety and fear that mastectomy will gain additional benefit to survival for woman, and it will not,” says Holmes. “So trying to correct that so that the decision about mastectomy is not a decision about survival, it’s a decision about (appearance).”
Contact Sarah Corsa at 702-3830353 or scorsa@reviewjournal.com. Follow @sarahcorsa on Twitter.