Reality check: Is mastectomy better for young women with early-stage breast cancer?

This Feb. 26, 2012 file photo shows actress Angelina Jolie at the 84th Academy Awards in the Hollywood section of Los Angeles.
This Feb. 26, 2012 file photo shows actress Angelina Jolie at the 84th Academy Awards in the Hollywood section of Los Angeles. (AP Photo/Chris Pizzello, file)

Angelina Jolie, among a handful of other celebrities, may have put breast cancer and mastectomy on the map.

Now, a new study suggests that for young women fighting early-stage breast cancer, mastectomy may decrease their risk of the disease resurfacing again.

It’s a tough decision to make for women grappling with breast cancer: get a lumpectomy and remove the tumours in the breast or have a mastectomy and remove the entire breast.

But in the latest findings, Danish researchers suggest that mastectomy could be a better bet in keeping away breast cancer recurrence.

Global News looks at the study’s findings and the bottom line from Canadian experts.

The study: Aarhus University Hospital scientists suggest that women who are 45 and younger and who had early stage breast cancer that hadn’t spread to the lymph nodes decrease their risk of recurrence if they get a mastectomy compared to getting a lumpectomy.

The study followed 1,076 Danish women over the course of 20 years who were diagnosed between 1989 and 1998. They were at low risk because their tumours were smaller than five centimetres in diameter.

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About 365 women had lumpectomies and another 712 had mastectomies. None of the women went through chemotherapy because of their low-risk classification.

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At the 20-year mark, 18 per cent of the women who had lumpectomies saw their cancer recur while only 6.7 per cent of the group who had mastectomies encountered the same fate.

For women had mastectomies, the cancer recurred within the first five years in older women while it took up to 10 years in younger women. For those who had lumpectomies, recurrence happened throughout the 20-year study period.

Sound bite: “When future treatment guidelines of young lymph-node-negative patients are refined, the possibility of the negative impact of breast conserving therapy on survival in these younger women should be taken into account,” lead author, Dr. Tinne Laurberg said in a statement.

Canadian experts weigh in:

These results are only a piece of a growing body of research into whether mastectomies are the better bet, according to Dr. Andrea Eisen, a medical oncologist at Sunnybrook Health Sciences Centre.

“The take-home message from this isn’t that every young woman needs a mastectomy. There are other studies that show different conclusions and there has been an over-emphasis about the potential benefits of mastectomy that goes against years and years of study,” Eisen told Global News.

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Keep in mind, the research looked at women in the 1990s. Cancer therapies that complement lumpectomy and mastectomy have come a long way, Eisen notes.

A recent Canadian study with young women who had breast cancer found that recurrence was about eight per cent for those who had a lumpectomy paired with chemotherapy, hormone therapy and radiation and three per cent for those who had a mastectomy, she said.

“[The study] doesn’t reflect what modern breast cancer treatments are. Women shouldn’t be afraid by this study of getting a lumpectomy and radiation. We have very good treatment and good data that shows the outcomes are strong,” she said.

There are other factors at play too, according to Dr. Tulin Cil, a surgical oncologist at Women’s College Hospital and Princess Margaret Cancer Centre.

“Treatment decisions are guided a lot by the disease that they have in terms of tumour size, lymph node status, risk factors, if they’re predisposed,” Cil explained. In some cases, mastectomy is the only option.

In Jolie’s case, for example, she carried the BRCA 1 gene, which puts her at an incredibly high risk of breast cancer. In those circumstances, mastectomy is wisest.

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For others, it is a tough call. There’s a psychological aspect, too: some women could be on wait lists for reconstructive surgery for months at a time. Others prefer lumpectomy because it preserves as much of the breast as possible.

“This has been controversial for some time. There has been mixed results in other studies and there are a lot of moving parts,” Cil said.

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