Introduction

Breast cancer is the most common cancer diagnosed in India and is the most common cancer in women. The recent advances in breast cancer treatment had led to excellent survival and cure rates. The surgical treatment of breast cancer initially involved Mastectomy (removal of whole breast), but now the treatment of choice is Breast Conservation Therapy (removal of only the tumour with preservation of normal breast), wherever feasible. Both options have their merits and drawbacks, and the choice should be guided by individual circumstances and preferences.

Understanding the Options

Breast Conservation Therapy (BCT):

BCT, also known as lumpectomy or partial mastectomy, involves surgically removing only the cancer tissue within the breast while preserving as much of the healthy breast as possible. This approach is usually followed by radiation therapy.

Advantages of Breast Conservation:

• Preserves the natural appearance of the breast, hence providing better patient satisfaction and improved quality of life. 
• It has a shorter recovery period compared to mastectomy.
• Provides similar survival / cure rates when compared to mastectomy

Considerations for Breast Conservation:

• May not be suitable for larger tumours or advanced stage cancers.
• Requires radiation therapy, which can have side effects.

Mastectomy:

A mastectomy involves the complete removal of the breast tissue irrespective of the tumour size and stage,

Advantages of Mastectomy:

• Reduces the risk of cancer recurrence in the breast, but no added advantage on the survival / cure rates.
• Recommended for patients with advanced or extensive disease
• Eliminates the need for radiation therapy in few cases.

Considerations for Mastectomy:

• Loss of the breast, which can impact body image and self-esteem.
• Longer recovery period and potential complications associated with surgery.

Making the Decision

The choice between breast conservation and mastectomy should be a shared and informed decision involving the patient and the oncology team. A Surgical Oncologist (Cancer Surgeon) should be adequately trained in performing both the kind of operations in order to offer the options to the patient.

Conclusion

The decision to undergo breast conservation therapy or a mastectomy is deeply personal and should be based on a careful assessment of individual factors. It’s crucial to have open and honest discussions with healthcare providers to make an informed choice considering both the medical needs and personal preferences.

Breast cancer treatment has made significant advancements in recent years, offering more options with improved survival rates. Ultimately, the goal of breast cancer treatment is not only to treat the disease but also to support the patient’s physical and emotional well-being i.e., quality of life.

References

Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer. JAMA Surg. 2014;149(3):267–274. doi:10.1001/jamasurg.2013.3049

Chatterjee, S. Is India Overdoing Mastectomy?. Indian J Surg 83 (Suppl 2), 275–277 (2021). https://doi.org/10.1007/s12262-020-02402-9

Fisher, Bernard et al. “Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.” The New England journal of medicine vol. 347,16 (2002): 1233-41. doi:10.1056/NEJMoa022152

Veronesi, Umberto et al. “Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.” The New England journal of medicine vol. 347,16 (2002): 1227-32. doi:10.1056/NEJMoa020989