Fewer Mastectomies and More Breast-conserving Surgery

Two Surgery Treatment Options

Early stage breast cancer—where the tumor is either precancerous or is cancer, but less than 3/4 inch in diameter—can be treated with one of two types of surgery. The more common type of surgery in the past has been a mastectomy, where the whole breast and sometimes nearby tissue is removed. With breastconserving surgery, only the tumor and part of the surrounding breast tissue is removed.

Since 1990, the National Institutes of Health have recommended that most women with early stage breast cancer have breast-conserving surgery followed by radiation treatment. This is an important advance in breast cancer therapy, because breast-conserving surgery offers most women the same odds of survival as a mastectomy, while a mastectomy is more disfiguring and can have painful after-effects.

More Breast-conserving Surgery

More California women are receiving breast-conserving surgery, instead of a mastectomy. In 1988, 32 percent of California women with early stage breast cancer had breast-conserving surgery. By 1999, the percentage had more than doubled to 66 percent.

Which Women Get Breast-conserving Surgery?

Regardless of her age, ethnicity, education, or income, a California woman diagnosed with early stage breast cancer today is less likely to have a mastectomy, and more likely to have breast-conserving surgery, than she would have in 1988.

However, some California women are more likely to have breast-conserving surgery than others. Among ethnic groups, a greater percentage of Asian/Pacific Islander and Hispanic women are treated with mastectomies compared to white and African American women. California women with higher incomes and more education are treated with breast-conserving surgery more often; a higher percentage of women with lower incomes and less education have mastectomies.

Why Some Women Still Have Mastectomies

One-third of California women with early stage breast cancer still have a mastectomy, even though breastconserving surgery is the recommended treatment. There are several possible reasons why.

Women may be following advice from their surgeons to have mastectomies. Some surgeons may recommend mastectomies to women whose tumors are near the high limit in size to be considered early stage. Surgeons get paid more for doing mastectomies, and some surgeons may not be presenting all the options to their patients. Health insurance plans may push some women to have mastectomies, because the overall cost may be less than breast-conserving surgery plus radiation. In situ tumors—precancerous tumors that may or may not progress to become cancer—are sometimes found in several places in a woman's breast. In these cases, the recommended treatment is usually removing the whole breast.

Women may also be deciding in favor of mastectomies for themselves. Some women may choose to have their entire breast removed to avoid the hardship of radiation. The recommended treatment is given five days per week for six weeks. Some women may live too far from the radiation facility to travel there every day. Women may fear being fired from their jobs if they take that much time off from work, or they may not have the necessary child care. Another reason some women may choose a mastectomy is the fear of the cancer recurring.

How This Research Was Done

Researchers used data from the California Cancer Registry on 219,744 California women diagnosed with breast cancer between 1988 and 1999. They included only women being diagnosed with the disease for the first time, and the information here is about the first treatment given these women. Information in this section comes from Chapter 10 of Breast Cancer in California, 2003, “Surgical Treatment of Female Breast Cancer in California,” by Cyllene R. Morris, D.V.M., Ph.D.