Even experts disagree and thus you may be faced with difficult choices at an emotionally vulnerable time.
The first decision is what type of surgery to have to remove the cancerous lump (either lumpectomy, just having the lump removed or mastectomy, having the whole breast removed). Long term survival for lumpectomy is the same as for mastectomy.
With lumpectomy you have the advantage of preserving the breast and having sexual sensation still present. Some doctors may have a unscientific bias towards mastectomy. Nonetheless mastectomy may be the best option with a very large tumour or several tumours in the same breast, or if radiation is not feasible.
At the time of the lumpectomy, some or all of the lymph nodes are routinely removed for diagnosis in finding out whether the cancer has spread. The lymph glands are an important part of the defense system against cancer. Removing them does not appear to extend long term survival. Side effects may include pain, numbness, swelling, and a limited range of motion in the arm.
The Head of Surgical Oncology at the B.C. Cancer Agency, Dr. Greg McGregor notes that the value of lymph node removal is becoming an increasingly controversial topic. Dr. McGregor is chief investigator in a new trial to see whether lymph node conservation affects lymph node reoccurrence or overall survival.
Dr. Edward Fish, former assistant professor of surgery at the University of Toronto, also questions the routine removal of lymph nodes, especially for women who have a small breast lump and no palpable lymph nodes felt in the armpit.
American breast surgeon Dr. Robert Kradijian , author of Save Yourself From Breast Cancer , believes axillary dissection is unnecessary in many cases, including women who have decided firmly for or against chemotherapy before surgery. He suggests a full discussion of risks and benefits with your surgeon.
A new technique is being developed where a radioactive blue dye is injected close to the tumour before it is removed. The dye then travels through the axilla to a lymph gland called the sentinel gland. The sentinel gland is then removed and if it contains no cancer cells, the lymph nodes can be safely left intact.
Radiation is usually offered with lumpectomy but unnecessary with mastectomy. Radiation does not extend your life but does reduce local reoccurrence of the cancer in the same breast by about 15 percent.
The main radiation side effects are fatigue and skin changes (redness, itching, peeling and blistering). Some of the changes in the skin may cause ongoing problems.
Dr. Fish studied 100 women who had lumpectomy only. Women over 65 with a small tumour with no aggressive features, had a local reoccurrence rate of less than 5 percent and would thus not benefit from radiation.
Finally there is the question of "preventative" chemotherapy to prevent distant spread of the cancer. In his thoughtful book, Breast Cancer (Prima Press, 1994) naturopathic physician Steve Austin says most women have severely impaired quality of life from chemotherapy but relatively few benefits.
Toxic side effects include hair loss, nausea, vomiting, and a dangerous lowering of your white blood cells making you susceptible to infection.
If you have no lymph node spread, you have a 70 to 80 percent chance of surviving free of disease without chemo. If you are a postmenopausal woman with no nodal spread, chemotherapy has minimal benefit. If you are a pre-menopausal woman with lymph node spread, the benefits are modest, a ten percent increase in overall survival. With a large or rapidly growing tumour, chemotherapy may be strongly recommended. Each woman has to weigh the risks versus the benefits for herself.
Still confused? One of the most clearly written and illustrated guides to sorting out conventional breast cancer treatment was written by three B.C. cancer specialists. The book is, Breast Cancer: All You Need to Know to Take an Active Part in Your Treatment , by Drs. Olivotto, Gelmon and Kuusk .
Finally, women are increasingly demanding access to information about alternative treatments for breast cancer. At a recent meeting in Vancouver forty doctors from across North America agreed to study unconventional breast cancer treatments.
An excellent manual, A Guide to Unconventional Cancer Therapies , was funded by Health Canada as part of the Breast Cancer Initiative Project (905-727-3300).
Another valuable tool is the Healing Choices Report , by Ralph Moss, a thirty to fifty page summary of alternative therapies for your cancer type. (718-636-4433)
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