Invasive Breast Cancer

Globally, breast cancer is the most common cancer and most lethal cancer in women.  In the USA, in 2012 there were more than 229,000 new case of invasive breast cancer diagnosed.

The surgical management of breast cancer included mastectomy and lumpectomy.

  • Mastectomy: removal of  ‘all’ the breast tissue; may be combined with reconstruction, or, without reconstruction; typically no radiation is necessary; chance of local recurrence (the return of the treated breast cancer in the same breast) is about 3%.  Reconstruction is often offered to patients undergoing mastectomy, and, can be done immediately or in a delayed fashion.
  • Lumpectomy: removal of the tumor and a ‘clear margin’ around the tumor; typically combined with radiation; no reconstruction necessary (typically); chance of local recurrence (the return of the treated breast cancer in the same breast, after radiation) is about 3-5%.
  • Despite what seems to be a more ‘aggressive’ surgery, there are no differences in outcomes between these two surgical approach’s (both overall survival (OS) and disease free survival/recurrence (DFS).
  • The only potential difference between these two surgical approaches, are the indications for adjuvant radiation therapy (more likely necessary in patients who undergo lumpectomy, and, less likely for patients who have a mastectomy).
  • Surgical management has no implications as it relates to:
    • indications for chemotherapy
    • indications for endocrine therapy (anti-estrogen)
    • the need for sentinel lymph node biopsy

DFS and OS

After 20 years of follow up there is simply no difference in outcomes (breast cancer coming back in the breast; breast cancer spreading to other organs; or dying from breast cancer) when comparing a lumpectomy to a lumpectomy with radiation, and, to a mastectomy.