For many women with localized breast cancer, a lumpectomy followed by breast radiation therapy may be the most effective treatment, with survival rates equal to a mastectomy. But if the cancer comes back, can women have additional lumpectomies?
Women should not have a second lumpectomy in the same breast if they were previously treated with a lumpectomy and radiation, says Mehra Golshan, MD, FACS, director of Breast Surgical Services at the Susan F. Smith Center for Women’s Cancers at Dana-Farber. Instead, the standard course of treatment is a mastectomy (total removal of the breast), with or without reconstruction, to avoid the additional radiation that would accompany a second lumpectomy.
“Radiation not only kills cancer cells, but it also inhibits the growth of normal cells,” he says. “There’s a limited amount of radiation that parts of the body can tolerate. Beyond that, there are issues with wound healing, and in some cases you can get radiation-induced cancers or toxicity to other parts of the body.”
Certain women older than 70 who have small, estrogen-sensitive tumors may not need radiation following a lumpectomy, making them eligible for a second lumpectomy should their cancer come back in the breast. Golshan says in some cases there is also the option to receive partial breast radiation, where therapy is given only to the site of the lumpectomy. If a woman is treated with partial radiation for her first cancer, she may be eligible for a second lumpectomy and partial breast radiation if she has a recurrence in another part of the breast. These areas are being researched actively.
Women who are diagnosed for the first time with breast cancer in multiple spots traditionally have had a mastectomy. However, a new trial at Dana-Farber/Harvard Cancer Center offers these patients multiple lumpectomies followed by radiation, rather than removing the entire breast.
Should a woman who was treated with a lumpectomy and radiation in one breast be diagnosed with a second cancer in her opposite breast, she may be eligible for another lumpectomy, as the second breast did not receive radiation.
But, Golshan cautions, “it’s somewhat uncommon to get bilateral breast cancer [cancer in both breasts], so we would want to consider genetic counseling and testing before offering her another lumpectomy.”
“If she has a genetic predisposition, such as a BRCA mutation, then we would offer her a mastectomy and potentially other procedures to lessen her risk of further breast or ovarian cancer,” he adds. If there is no mutation, a lumpectomy of the opposite breast would be an option.