Mastectomy vs. Lumpectomy: An Interview with Susan Love, M.D.

Susan Love, M.D., is an adjunct professor of Surgery at UCLA and the medical director of the Susan Love MD Breast Cancer Foundation, a nonprofit organization dedicated to the eradication of breast cancer. She is the author of "Dr. Susan Love's Breast Book" and "Dr. Susan Love's Hormone Book."

Can you talk about how attitudes toward mastectomies have changed in the last decade?

Well I think we have certainly changed the attitude toward mastectomy a lot in the last decade. It used to be that we felt like you had to cut the breast off because it was the only way to prevent it from spreading. And now that we have realized that breast cancer has been there eight to ten years by the time we come around it and rushing in and cutting the breast off is not what is going to save somebody.

We have realized that lumpectomy and radiation are equal. It is interesting, though, that in spite of the fact that all the data shows that they are equal, there are still many surgeons in this country who are recommending mastectomies and I am still hearing of many patients who are getting mastectomies because they somehow have the idea that that is a better, more aggressive treatment.

When you do a mastectomy you never get all the breast tissue and so there still is a local recurrence rate of about five to ten percent in the scar. If you do a lumpectomy and radiation there is a local recurrence rate in the breast of about five to ten percent. So they are equal in terms of preventing breast cancer from coming back in the breast.

They are also equal in terms of preventing cancer from coming back anywhere else in the body because most cancers have been there eight to ten years and those cells are out by the time you get there. So either your immune system is going to take care of them or the chemo or the hormones will take care of them. But what surgery you do is not going to make a difference on whether you live or die.

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So why would a woman choose to have a mastectomy not a lumpectomy?

Well, the only medical reason to have a mastectomy rather than a lumpectomy and radiation is if the tumour is so big in comparison to the size of the breast that you can't get it out any other way. Apart from that some women choose mastectomy because they don't want to have radiation or they live a distance from where they can get radiation.

Radiation is five weeks and so it can be a little bit of a time thing, but that is really one of the only arguments. Unfortunately, even today in 2001 there are doctors who are really not giving women the options. They say, "well, you can have a lumpectomy and radiation if you want but if you were my wife or you know if it were up to me I would do a mastectomy." And of course when women hear that they think, oh well, he knows something or she knows something I don't know and they end up choosing the mastectomy, thinking somehow they are getting a better deal.

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Do you think that preventative mastectomy is necessary these days or, let's say, in a few years time? Should a girl who has a genetically very high risk of breast cancer be thinking of a preventative mastectomy?

It is only very recently that we have gotten data on preventative mastectomy that show that it actually does some good. Prior to that we really didn't know. It looks like it will prevent about ninety percent of breast cancers in women who are high risk.

But it is a very crude way to prevent breast cancer ... My hope is [that] with some of the newer research we will be able to figure out much better ways to prevent breast cancer. I think we are in a little time period now where it is all we have but I doubt that this will be what we will be using in five years.