Why a Mastectomy may not work as well as just removing the lump

A mastectomy is often seen as the surest way to stop breast cancer recurring.

But latest research suggests women live longer if just the tumour is removed rather than the whole breast.

Survival rates were better among patients who had a lumpectomy — where only cancerous tissue is taken out — plus radiotherapy, than among those who had a mastectomy (full breast removal).

They also had a lower risk of complications.

The findings, by UK scientists, could reduce the number of women having mastectomies on the NHS in favour of less aggressive treatment.

A mastectomy is often seen as the surest way to stop breast cancer recurring and about 15,000 women every year in the UK undergo the operation

Breast cancer is the UK's most common form of the disease, with more than 55,000 new cases a year

About 15,000 women every year in the UK undergo the operation.

As well as a higher risk of complications (such as infection and scarring), the surgery can also have a serious effect on women's sex lives and mental health, even if they have a breast reconstruction.

In addition, some evidence suggests the cancer can sometimes return. Post-mastectomy, this is usually in the lungs, liver, bones or brain. One theory is that this is because the major surgery has a significant impact on the body, suppressing the immune system and allowing any rogue tumour cells left behind to proliferate.

Breast cancer is the UK's most common form of the disease, with more than 55,000 new cases a year.

Treatment usually begins with a lumpectomy, followed by radiotherapy or chemotherapy, or a mastectomy to remove one or both breasts, again sometimes followed by radiotherapy or chemotherapy.

B ut in the latest study, researchers from Bristol Medical School and Liverpool University Hospitals found that women who'd had a lumpectomy and radiotherapy lived longer overall than those who had one or both breasts removed. This was regardless of whether they had radiotherapy too.

It also found that lumpectomy and radiotherapy led to better survival rates than mastectomy for women under the age of 50.

The research, published in the British Journal of Surgery Open, used data from 35 studies, involving more than 900,000 women over a 23-year period.

The results echo those from a larger study, involving 1.5million patients with early-stage breast cancer, published in the Annals of Surgical Oncology in 2022.

In this study, researchers at Tufts University School of Medicine in the U.S. also found longer survival times in those who had a lumpectomy along with radiotherapy, rather than a mastectomy.

The UK team said the reasons are not clear but improvements in radiotherapy, hormone treatments and immunotherapy (which boosts the immune system to kill cancer cells) may be key, as they allow for tumours to be targeted precisely.

The new findings were welcomed by Professor Kefah Mokbel, chairman of breast surgery at the London Breast Institute, at the Princess Grace Hospital in London.

He told Good Health it could lead to the number of NHS mastectomies being halved in future.

'The common perception of 'peace of mind' associated with mastectomy is unfounded,' said Professor Mokbel.

'By preserving the breasts, we not only maintain the quality of life but also potentially enhance the quantity of life for patients.'

He said if the cancer recurs it is usually in the breast, and local recurrences can normally be treated with another lumpectomy.

But if the breast has been removed, the cancer settles elsewhere, which can make treatment more difficult and affect outcome.

However, the professor said mastectomy may still be preferable for some patients, such as those with large or multiple tumours.

Statins cut the risk of dying from breast cancer by 15 per cent, according to U.S. research reported in the journal Cancer.

This showed that while the cholesterol-lowering pills did not reduce the danger of the cancer recurring, they did lower the chances of dying from it if it did come back.

Animal studies show statins can stunt tumour cell growth by cutting the cholesterol needed to make oestrogen, which fuels the growth of some breast tumours.