Monday, January 24, 2011

Mastectomy versus lumpectomy

One of the many woulda, shoulda, couldas of my life was opting for a lumpectomy instead of a mastectomy. I had based my decision on the fact that I though I had a small tumor (which ended up doubling in size and number by the time surgery rolled around) and my surgeon's insistence that my survival would be absolutely the same in either case. But not long after I had the two surgeries (bad margins and lots of possible DCIS), I was reading that in the case of hormone negative BC, survival is actually better with mastectomies. If you are BRAC1, they recommend mastectomy. Most BRAC1 have TNBC but not all TNBC is BRAC1. Even though my history does not suggest BRAC1, still there must be some defect that could lead to another tumor.

Anyway at the recent San Antonio Breast Cancer conference, they announced a huge study that showed for hormone negative patients over 50 (c'est moi!) the lumpectomy ladies were 17% less likely to die than the mastectomy ladies (see http://www.webmd.com/breast-cancer/news/20101217/breast-conserving-therapy-better-than-mastectomy). Good news for me but as this contradicts earlier studies and I am so cynical, I wonder if some sort of bias is in play between the two groups. First of all, the BRAC1 ladies wouldn't be in the lumpectomy group. In general, their survival is lower (though recent studies dispute that). If there is wide spread DCIS, time for a mastectomy! So in general, it seems that the patients who are most likely to recur have the mastectomies, so of course they probably have lower survival rates.

At high school orientation, they stress the importance of student athletics saying that the grade point averages of the athletes is higher than the non-athletes. But if you have a bad GPA, you can't be on a team so that sort of biases the results right there. Another favorite statistic of mine is that breast fed babies have higher IQs that formula fed babies. But it is mainly middle to upper class ladies doing the breast feeding.....

Snow, snow..go away. It finally isn't so cold out but with 2 inches of new snow, it is slippery out, so again to the gym. We went out to eat with Josh and Julia yesterday, which was nice. Today Ms. Maya and her mom came over for a bit. I will go over there shortly so Naomi can go to class.

3 comments:

Holly said...

i, too, wish i had opted for bilateral mastectomies...i could have avoided radiation which continues to cause me all sorts of problems...what does your research show about DM II? any insight or info would be greatly appreciated...

Sue in Italia/In the Land Of Cancer said...

I will look into this more. In general, the factors that put you at more risk for recurrence put you at more risk for DM II such as larger than average BMI, lack of exercise. However metformin seems to deprive TNBC cells of the glucose that they seem to thrive so much on that it is being considered for non DM patients. You have hit that magic 3 year mark, haven't you in which your risk goes way, way down.
If I see any link between diabetes and TNBC, I will report.

nancyspoint said...

Hi Sue, Saw your blog on Daria's, so sad about her isn't it? Anyway this post caught my eye. In some ways I feel lucky I tested positive for BRCA2 because my doctor told me in no uncertain terms, bilateral was the way to go. If I had not tested positive, I probably would have thought twice about it. (well actually a lot more than twice.ha) Not that I still can't have a recurrence, but my odds against it are at least improved somewhat. At least I hope they are! Great post.

Followers

Blog Archive