Deciding Between Lumpectomy and Mastectomy: How Breast Cancer Patients Choose

That one piece of advice from a nurse navigator really stuck with me in 2013 when I was given three options to treat the DCIS (Stage 0 breast cancer) found in my right breast after my first mammogram at age 39:

Lack of information leaves patients second-guessing

I mulled this over for a good couple of weeks, feeding the stress I was already under. The advice was both reassuring – I will make the right decision – but also self-serving – do patients simply justify the choice after it is over to make themselves feel better?

My care team accepted my decision to have a unilateral mastectomy (right breast only). When I asked them for pros and cons of the lumpectomy vs. mastectomy, they provided answers. However, there were several things I learned after the surgery that I wish I had known before:

Radiation post-surgery needs more discussion

And then there were the major issues when I had a recurrence and needed radiation years later. Radiation itself does not hurt, but it changes the breast and tightens it up quite a lot. This tightening over the areas of fatty necrosis in my breast left me with a baseline level of constant mild pain.

But for many of my friends who had only been offered implants, their quality of life post-radiation was significantly affected by the breast tissue being stretched tightly across the implants, leading to even more impossible choices.

Difficult decisions can be made easier

Medicine evolves rapidly, and I am not sure if I would be offered the same choices 13 years later. Would I make the same decision? I think so. Would I also lament that I was not given all of the information before deciding? Definitely.

People affected by cancer face a myriad of decisions every day against a backdrop of fear and uncertainty about their future, all while simultaneously working or going to school, being a parent, and often caring for others themselves.

There is so much that the makers of the devices, diagnostics, and medicines can do to meet patients where they are and provide education in bite-size ways tailored to them. But to do that, they need to really understand the patient mindset and how the physicians and care team are positioning these choices.

At Oncospective by Cetas, we provide biopharmaceutical teams with a direct line of sight into the decision-making of medical oncologists, surgical oncologists, cancer patients, and all other stakeholders contributing to cancer care. We do this by asking them the right questions, not just the ones on the surface.