Less is as good as more – and sometimes better – when it comes to breast cancer surgical procedures, area doctors say.
Not only are minimally invasive lumpectomies just as effective as total breast removal for most patients, they said, but the need for additional surgery is usually reduced.
“Sentinel node biopsies have revolutionized how we treat breast cancer,” Dr. Gerard Garguilo said.
“We are doing less surgery and getting more useful and helpful information.”
Up until a few years ago, when cancer was treated with a minimally invasive lumpectomy, the surgeon would remove several lymph nodes from the patient’s armpit area.
Lymph nodes are part of system of glands and vessels carrying lymphatic fluid just under the skin.
Breast cancer usually shows up first in the lymph nodes if it is spreading to other organs, Garguilo said at Conemaugh Physicians Group – Johnstown Breast Center, 1111 Franklin St.
Research identified the first nodes affected by the spread of cancer, so surgeons now only check those one or two nodes, Garguilo explained.
That means there is less chance of complications from additional lymph node removal.
Lymphedema, which can cause painful swelling in the legs, is one common complication.
“If the sentinel nodes are negative, we no longer have to do the full axillary dissection,” Dr. Diana Craig said from UPMC Altoona.
‘My job is to educate’
Unless a patient’s genetic testing shows her at high risk for more cancer, a lumpectomy with follow-up radiation therapy is as effective as a mastectomy.
Nationally, however, figures show a slight increase in breast cancer patients choosing to have a mastectomy, or even a double mastectomy, instead of the minimally invasive lumpectomy.
Dr. Patti Ann Stefanick has seen the shift locally, with more patients having mastectomies followed by immediate reconstructive surgery.
“Plastic surgeons just follow me in (to the operating room), and they do the reconstruction,” Stefanick said at her office at 939 Menoher Blvd. in Southmont. “It’s all done the same day. They wake up, they have breast tissue.”
Stefanick believes that fear is driving the choice for breast removal.
“Even if they are negative (for genetic risk), a lot of these people don’t want to go through this again – especially with reconstruction on the table,” she said. “Plastic surgeons know what they are doing here.”
Dr. Debra Sims at Joyce Murtha Breast Care Center in Windber has not seen much of an increase in requests for mastectomies. She tries to help patients understand the pros and cons of all options.
“My job is to educate them,” Sims said at the Chan Soon-Shiong Medical Center at Windber center. “I try to spend an hour. When you’ve been diagnosed with breast cancer, someone should sit down and talk to you about what happens.”
Sims said she explains what research shows about effectiveness, safety and side effects of treatment options.
“I tell people I want to do the least amount of surgery we can do to treat the cancer,” she said. “I say, it is not just what I’m going to do. There’s the radiation oncologist, the medical oncologist. It is a group of people working together. We can offer them all the different options.”
Understanding the risk
Surgical removal of cancer can include nipple-sparing and skin-sparing surgery. Both are offered in Windber.
Although it is always the patient’s choice, Sims stresses that there is no difference in survival rate between lumpectomy and mastectomy among patients who are eligible for either.
Recovery also is quick, she said.
“Thirty to 40 percent of my patients never take more than a Tylenol,” Sims said. “I have found if they don’t wake up with pain, they don’t get pain.”
Garguilo also said his patient-education focus may be the reason he’s not seeing more mastectomies.
“I don’t know that I’ve seen that (trend) to the same extent that it is discussed in the literature or even in the press,” Garguilo said. “Women may very well be more comfortable with my explanation about the value of a lumpectomy.
“I want to make women fully understand the actual risk of developing another cancer or getting cancer in the other breast is the same with either.”
‘Know your body’
All four breast surgeons encourage annual mammograms, beginning around age 40.
Sims, Stefanick and Craig encourage regular breast self exams, although they recognize that studies have not proven that is a valuable screening practice.
“They are going to notice the difference before anyone else will,” Stefanick said. “The gynecologist or family doctor may only get to see these ladies once a year, if that. If the ladies are doing it every month, they are looking for changes.”
She teaches patients how to check their breasts for lumps and changes.
“You need to know your body, whatever that takes,” Craig said
“I tell people, if you don’t know the texture of your own breast, you are not going to know if something new comes along.”
Sims has similar advice.
“I think it is awareness of your body and trying to take care of your health,” she said.
“Women should be doing breast self exams on a monthly basis.”
Garguilo does not discount the possible benefit of breast self exams, but said he knows not all women are comfortable with the practice.
“I will have people do it if they are comfortable with it,” he said. “I leave it up to the patient.”