Monday, July 16, 2012

1 in 5 Women With Breast Cancer Have Multiple Surgeries

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A recent study of more than 55,000 British women showed that twenty percent of patients who initially opted for breast-conserving surgery (i.e. lumpectomy or partial mastectomy) underwent additional surgery to remove more tissue. Approximately forty percent of these re-operations were for a total mastectomy.

A study published by the Journal of the American Medical Association last year puts the repeat rate for American women at closer to 1 in 4, or twenty-five percent. Additonally, women diagnosed with DCIS were more than twice as likely to have additional surgery.

Finding out you have breast cancer is scary. Having to decide between a lumpectomy with radiation or a total mastectomy is like choosing between swimming with a life vest through shark infested waters or white water rafting down the Colorado River without a paddle. Neither is preferred and both ensure risk and sacrifice.

For me, the choice to have a mastectomy was made for me. My multi-focal, multi-centric DCIS made having multiple lumpectomies both cosmetically and surgically implausible. While radiologists identified three sites in my right breast prior to surgery through biopsies, ten sites were ultimately found once the final pathology report was completed post-op. One of the sites had micro-invasions; I shutter to think what may have developed had I chosen to have a lumpectomy instead were that an option for me.

My decision was between having a single or a double mastectomy and it was a choice I struggled with for a few weeks. I had a difficult time wrapping my head around removing something healthy however I did not want to live waiting for the proverbial other shoe to drop. The pathology report confirmed that there was no cancer present in my left breast so ultimately my decision was a prophylactic one. I am completely confident I made the right decision and am one hundred percent regret-free and happy.

While much of my research was based on anecdotal information, I found myself honing in on stories of women who initially opted for a lumpectomy only to find out that their cancer had returned and lamented the fact that they had to endure both the emotional and physical stress of surgery and treatment all over again. During my first consultation with the surgical oncologist, and when I originally thought there was only one site, he mentioned that should the cancer return, the cosmetic results the second time around would be far less than optimal if I had already undergone a lumpectomy with radiation. This definitely weighed on me.

It's true that you have to do what feels right for you however I was most appreciative of the friends and doctors who gave me their blunt opinions and recommendations. I found it easier to frame my own decision against the clear and definitive advice offered by some rather than the "let-your-heart-tell-you-what-to-do" versions. You have to know your audience though...some people need a more delicate approach.

Doctors are quick to emphasize that survival rates for women having a mastectomy and those opting for lumpectomy with radiation are nearly the same however some cancers are not easy to detect and breast-conserving surgeries may miss removing all of the tumor.

Researchers say that prior to this study, doctors would routinely warn women of the possible risk for further surgery however they now say that women can make their decision based on actual data.

Is twenty-five percent a risk you can live with to save your breast?

Let me know your thoughts.

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