29 doctors weighed in:
How can a patient still have cancer after lumpectomy? Cant find good surgeon (even if rich celebrities)? Not fair to need mastectomy vs radiation, etc
29 doctors weighed in

Dr. Devon Webster
Internal Medicine - Oncology
17 doctors agree
In brief: Breast neighborhood
It's not the surgeon, it's the bad breast neighborhood that allows cancer to return.
Cancer cells can sneak away from the tumor before surgery, which is why radiation therapy is necessary after any lumpectomy. Even with radiation, there is a higher chance of cancer returning after a lumpectomy compared to mastectomy. You're right, it's not fair. We need better treatments for breast cancer.

In brief: Breast neighborhood
It's not the surgeon, it's the bad breast neighborhood that allows cancer to return.
Cancer cells can sneak away from the tumor before surgery, which is why radiation therapy is necessary after any lumpectomy. Even with radiation, there is a higher chance of cancer returning after a lumpectomy compared to mastectomy. You're right, it's not fair. We need better treatments for breast cancer.
Dr. Devon Webster
Dr. Devon Webster
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2 comments
Dr. Kathryn Wagner
The local recurrence rate for lumpectomy at 10 yrs is around 5-8%; for mastectomy around 8%; at 20 yrs lumpectomy is around 14% and mastectomy stable at 8-10%. This assumes radiation and negative margins for lumpectomy; and neg margins for mastectomy; assumes negative nodes for both.
Dr. Kathryn Wagner
Opposite breast cancer in a survivor is around 0.6% regardless of lumpectomy or mastectomy. Assumes standard of care treatment for the known cancer and no genetic predisposition/high risk status
Dr. Barry Rosen
Surgery
15 doctors agree
In brief: Breast Conserving Rx
Many well-designed studies have proven that lumpectomy alone is insufficient local rx of breast cancer due to high rates of local recurrence; radiation therapy (rt) to the breast is necessary to reduce this rate to acceptable levels.
Unfortunately, some people are not candidates for rt, in which case mastectomy is necessary. Second opinions are often very helpful to clarify these issues.

In brief: Breast Conserving Rx
Many well-designed studies have proven that lumpectomy alone is insufficient local rx of breast cancer due to high rates of local recurrence; radiation therapy (rt) to the breast is necessary to reduce this rate to acceptable levels.
Unfortunately, some people are not candidates for rt, in which case mastectomy is necessary. Second opinions are often very helpful to clarify these issues.
Dr. Barry Rosen
Dr. Barry Rosen
Thank
4 comments
Dr. Michael Thompson
2 issues. 1) Local control lumpectomy+radiation = mastectomy (generally). 2) systemic control. Micro (not seen on imaging etc) metastatic (spread) breast cancer is NOT treated by local treatments (surgery or radiation) and hormone or chemotherapy (or now diet/exercise in studies) may (depends) be helpful to reduce the risk of distant recurrence. The risk/benefit ratio varies for each individual.
Dr. Kathryn Wagner
Agree with above. Unfortunately, sometimes the earliest form of breast cancer, DCIS, is not seen on ANY preoperative imaging and it is not known to be there until the margins are positive after lumpectomy. This is a very common reason for failed lumpectomy. Radiation can't clean this up, only more surgery.
Dr. Andrew Turrisi
Radiation Oncology
5 doctors agree
In brief: ?
One can go with lumpectomy alone if they accept a risk of 3-5% per year of local failure leading to breast loss, and a loss of the survival benefit of raiotherapy.
However, all cases are not amenable to lumpectomy (size to big, persistent postive margins). There are plenty of good surgeons and radiation oncologists that will work with you.

In brief: ?
One can go with lumpectomy alone if they accept a risk of 3-5% per year of local failure leading to breast loss, and a loss of the survival benefit of raiotherapy.
However, all cases are not amenable to lumpectomy (size to big, persistent postive margins). There are plenty of good surgeons and radiation oncologists that will work with you.
Dr. Andrew Turrisi
Dr. Andrew Turrisi
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Dr. Carl Van Wey
Radiation Oncology
4 doctors agree
In brief: Breast cancer
Multiple clinical trials over decades show that lumpectomy alone is not adequate treatment for most (not all) patients, because there is often more cancer cells in the breast, beyond the "lump".

In brief: Breast cancer
Multiple clinical trials over decades show that lumpectomy alone is not adequate treatment for most (not all) patients, because there is often more cancer cells in the breast, beyond the "lump".
Dr. Carl Van Wey
Dr. Carl Van Wey
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Dr. Marsha Davis
Internal Medicine
3 doctors agree
In brief: No good answer
Even mastectomy does not preclude previous circulating microscopic cells.
The body has natural killer immune cells that hopefully can eradicate these small amounts of cancer cells given other appropriate therapies.

In brief: No good answer
Even mastectomy does not preclude previous circulating microscopic cells.
The body has natural killer immune cells that hopefully can eradicate these small amounts of cancer cells given other appropriate therapies.
Dr. Marsha Davis
Dr. Marsha Davis
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Dr. Reza Shirazi
Radiation Oncology
3 doctors agree
In brief: Microscopic disease
I hear your frustration.
Expert surgeons will remove the macroscopic disease ( what he/ she can see by his/ her eyes), but the nature of the beast is microscopic disease that can not be seen by naked eyes. Radiation can sterilize this effectively similar to mastectomy. There is some more recent experience with partial breast radiation that is promising.

In brief: Microscopic disease
I hear your frustration.
Expert surgeons will remove the macroscopic disease ( what he/ she can see by his/ her eyes), but the nature of the beast is microscopic disease that can not be seen by naked eyes. Radiation can sterilize this effectively similar to mastectomy. There is some more recent experience with partial breast radiation that is promising.
Dr. Reza Shirazi
Dr. Reza Shirazi
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Dr. Marci Dietrich
Bariatrics
1 doctor agrees
In brief: Lumpectomy
An expert physician in breast cancer is necessary to give the statistics necessary to decide on a lumpectomy.
A good expert gives the positives and negatives of a treatment, likelihood of a recurrence. Not all surgeons are equal in their ability to treat breast cancer. Always, get a second, or even a third opinion. Educate yourself, have a family member become a great source of info for you--read.

In brief: Lumpectomy
An expert physician in breast cancer is necessary to give the statistics necessary to decide on a lumpectomy.
A good expert gives the positives and negatives of a treatment, likelihood of a recurrence. Not all surgeons are equal in their ability to treat breast cancer. Always, get a second, or even a third opinion. Educate yourself, have a family member become a great source of info for you--read.
Dr. Marci Dietrich
Dr. Marci Dietrich
Thank
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