Mingxin Chen, MHS and Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

In December 2012, the U.S. Food and Drug Administration (FDA) approved Sientra’s “Silimed silicone gel breast implants.” These implants are also called “gummy breast implants” because they are made of a thicker gel that is said to resemble candy gummy bears.

To gain approval, the company was required to submit the results of a clinical trial to prove that the implants were safe and effective. A 5-year study of these implants was published in the November 2012 issue of Plastic and Reconstructive Surgery, authored by three Sientra employees and several plastic surgeons who were paid by Sientra to conduct the research.[1] The study included 1,788 participants with 3,506 breast implants.

Re-operation, Rupture, and Capsular Contracture

The three major complications measured were need for a re-operation, rupture, and capsular contracture. They can occur at any time, and become more common as the implants age. Capsular contracture refers to the formation of scar tissues around breast implants which becomes hard and potentially painful as the patients’ immune system reacts to the implant. MRIs were conducted on 571 of the 1788 participants to assess rupture that has no obvious symptoms.

The study indicated that the overall risk of rupture during the five years of the study was 2%, but that is misleading because the rupture rate was higher when “silent ruptures” measured by MRI were counted. MRI is the most accurate way to determine if an implant is ruptured, and more than 4% of first-time augmentation patients had a rupture within 5 years, which is much higher than expected. The risk of capsular contracture was 9% overall, and did not vary much for the different types of patients.

In contrast, the risk of reoperation varied considerably: 43% for first time reconstruction patients, 48% for reconstruction revision patients, compared to 17% for first time augmentation patients and 30% for augmentation revision patients. Revision patients are those whose previous implants were replaced with the Sientra implants.

Other Complications

There were many other complications affecting appearance and health. Most complications are highest for patients whose implants are for reconstruction after mastectomy; for example, 11% have asymmetry, 5% have an infection; 4% have breast pain, 4% of the implants are not in the correct position, and 3% have abnormal scarring. Complications are even higher for reconstruction patients who had earlier implants replaced by Sientra implants: 15% have breast asymmetry, 7% have implants in the wrong place, 5% have breast lumps or cysts, and 4% have breast pain.

For first-time augmentation patients, 3% have nipple sensation changes (either losing sensation or painfully sensitive) and 3% have sagging breasts. As noted earlier, reoperation, capsular contracture, and rupture are more common. Other complications, such as pain and swelling, add up, but each of these others complication is below 3%. Among revision augmentation patients, 5% have implants in the wrong position, 3% develop sagging breasts, 3% have wrinkling around the implant, and 3% have breasts that look asymmetrical.

Despite these high level of complications within only five years was high, the authors defended the implants. For example, they stated that over half of the patients who removed or replaced their implants did so for cosmetic reasons, predominantly patient request for style/size change. Regardless of the reason however, additional surgery is expensive and puts the patient at risk. And for breast cancer patients who chose mastectomy and implants so they would not have to think about cancer, these surgeries are a very unwelcome reminder.

The authors claimed Silimed is superior to the other two implant brands, Allergan and Mentor, in terms of risk of complications, as its risk of capsular contracture among first-time and revision augmentation patients within 5 years is 9% and 8%, in comparison with Allergan’s 13% and 17%, and Mentor’s 9% and 20%, both within 4 years.

Sientra, based in Santa Barbara, California, is the third largest global manufacturer of silicone implantable devices. The approval of the first gummy bear implants was welcomed by plastic surgeons, who pointed out that these implants had been manufactured and distributed outside of North America for 15 years.  However, the FDA approved the implants based on only 3 years of data, rather than the longer studies that would have been possible since the implants were on the market for 15 years.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

Reference

Stevens, W. G., Harrington, J., Alizadeh, K., Berger, L., Broadway, D., Hester, T. R., . . . Beckstrand, M. (2012, November). Five-Year Follow-Up Data from the U.S. Clinical Trial for Sientraʼs U.S. Food and Drug Administration–Approved Silimed® Brand Round and Shaped Implants with High-Strength Silicone Gel. Plastic and Reconstructive Surgery, 130(5), 973-981.

Tracy Rupp, PharmD, MPH, RD and Mingxin Chen, MHS, Cancer Prevention & Treatment Fund

Although people all over the world can develop cancer, cancer patients are more likely to survive in areas of the world that receive the most sun.[1]  Since our skin makes vitamin D when exposed to sun, researchers wondered if vitamin D protects against cancer.  New research suggests that vitamin D may help women diagnosed with breast cancer to survive the disease.

The Evidence for the Role of Vitamin D in Breast Cancer

In November 2016, a study published in a major cancer journal looked at the association between vitamin D levels and survival in 1666 women with newly diagnosed invasive breast cancer in California. Among the participants, women with the highest vitamin D levels in their blood (the top one-third among the women in the study) were 28% less likely to die from all causes as compared to women with the lowest vitamin D levels (bottom one-third) in their blood. The association between vitamin D and survival was even stronger in premenopausal women: those with the highest vitamin D levels were 55% less likely to die from all causes and 63% less likely to die from breast cancer, as compared to premenopausal women with the lowest vitamin D levels.[2]

These results are similar to a study published in 2014, which also found that women with higher levels of vitamin D were more likely to survive breast cancer. This study used meta-analysis to pool the results from 5 previously published studies of the relationship between vitamin D levels and mortality from breast cancer. The study found that among 4443 breast-cancer patients, women with the highest vitamin D levels (about 30 ng/mL) were about half as likely to die from breast cancer as those with the lowest levels (less than 20 ng/mL).[3]

Since both studies found that women with higher vitamin D levels were more likely to survive the disease, we wonder: could the chances of improving survival really be so simple? Not necessarily. These two studies can’t tell us which came first: breast cancer or low vitamin D levels. For example, it’s possible that breast cancer causes vitamin D levels to drop. That’s one of the reasons it would be premature to recommend more vitamin D for women diagnosed with breast cancer.

The Evidence for the Role of Vitamin D in Melanoma

A study published in 2016 found that low levels of vitamin D may result in worse outcomes for patients diagnosed with the type of skin cancer called melanoma.[4] In this study, melanoma patients who had vitamin D levels less than 20 ng/mL were more likely to have larger tumors and more advanced disease than melanoma patients with higher levels of vitamin D. The researchers also examined inflammation and found that low vitamin D levels predicted poor outcomes for patients regardless of their levels of inflammation.

This result may seem very surprising, since sunlight exposure increases vitamin D and also increases the risk of developing skin cancer. A study is ongoing in Belgium to see whether vitamin D supplements will reduce the chances of skin cancer returning or worsening.[5] While it’s too early to recommend widespread vitamin D supplements for skin cancer, it’s reasonable to check vitamin D levels in patients with melanoma or who have been treated for melanoma. If their vitamin D levels are low, a supplement is an easy way to try to bring levels into the normal range.

What Is Vitamin D?

Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. Our bodies make vitamin D when our skin is exposed to direct sunlight. We can also benefit from the vitamin D that is added to milk and cereals.

How Much Vitamin D Is Recommended for Healthy People?

Approximately one-third of children and adults in the U.S. (over 1 year of age) do not get enough vitamin D.[6] The Institute of Medicine recommends the following daily amount of vitamin D for average healthy adults:[7]

• For those between 1 and 70 years of age, including women who are pregnant or lactating, the recommended dietary allowance (RDA) is 600 IU per day.
• For those 71 years or older, the recommendation is 800 IU per day.

Experts agree that just 15 minutes of sun at mid-day in the summer is enough. Of course, this varies based on how much skin is exposed (darker skinned people may need more time), the time of the day (mid-day is best for vitamin D), altitude (the higher the altitude you are at the more vitamin D your body can make). It is also more difficult to get enough make enough vitamin D from the sun during the winter. If you live anywhere north of Los Angeles, then you really can’t get much vitamin D from November to March when the sun is very low in the sky. Thus, we have to rely on the vitamin D we were able to store up during the summer or the vitamin D we can take in through our diets and supplements.

How Much Vitamin D Is Too Much?

Given the possible link to reducing cancer, you might wonder if you should take vitamin D supplements even though the results of these studies are not conclusive. It is important to remember that too much of any nutrient, including vitamin D, can be unhealthy. The safe maximum of vitamin D for adults and children older than 8 years of age is about 4000 IU per day.[8]

Dietary supplements are more likely than foods to provide too much vitamin D.  Although too much sun exposure is dangerous because of skin cancer, it will not cause vitamin D toxicity.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

Reference

1. Grant WB. Ecologic studies of solar UV-B radiation and cancer mortality rates (abstract), Recent Results Cancer Res. 2003;164: 371-7.
2. Yao, S., Kwan, M. L., Ergas, I. J., Roh, J. M., Cheng, T. D., Hong, C., . . . Kushi, L. H. (2016). Association of Serum Level of Vitamin D at Diagnosis With Breast Cancer Survival. JAMA Oncology.
3. Mohr SB, Gorham ED, Kim J, et al. Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Research. 2014;34:1163-66.
4. Fang S, Sui D, Wang Y, et al. Association of vitamin D Levels with outcome in patients with melanoma after adjustment for C-reactive protein. J Clin Oncol. 2016;34:1741-1747.
5. Vitamin D supplementation in cutaneous malignant melanoma outcome. ClinicalTrials.gov Identifier: NCT01748448. https://clinicaltrials.gov/ct2/show/NCT01748448?term=Vitamin+D+supplementation+in+cutaneous+malignant+melanoma+outcome&rank=1 Accessed January 19, 2017.
6. National Center for Health Statistics. NCHS Data Brief: National Health and Nutrition Examination Survey, 2001–2006. Available from: http://www.cdc.gov/nchs/data/databriefs/db59.pdf. Accessed September 21, 2015.
7. Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011.
8. Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011.

Susan Dudley, PhD, Cancer Prevention & Treatment Fund

Inflammatory breast cancer is a rare type of breast cancer that is very fast-growing and aggressive. It makes up only one to five percent of all breast cancer patients—so infrequent that many breast care specialists have never met a patient who has it.

Inflammatory breast cancer does not typically form a lump inside the breast. Instead, the first symptoms are usually clearly visible on the breast, and they are often similar to the symptoms of relatively harmless insect bites, skin conditions, or breast infections that have no relation to cancer.

Be alert for:

• changes in the size or profile of the breast that can include a) unusual swelling or enlargement, or b) “inversion” or flattening of the nipple
• changes in the color of the skin on a third or more of the breast that may look like a rash or bruise and may be red or purple
• changes in the texture of the skin such as thickening, development of “ridges” or of dimples or pits that look a bit like the texture of the skin of an orange
• changes in how the skin feels such as persistent itchiness or being warm to the touch
• swelling in the lymph glands that are under the arm or over the collar bone.

Compared to other types of breast cancer, inflammatory breast cancer is more common in younger and African American women, as well as women who are obese. Research published in 2022 reported that the use of sentinel lymph node biopsies has increased and become frequent in U.S. patients with inflammatory breast cancer, but that is not based on evidence or supported by current treatment guidelines.[1] Like other types of breast cancer, inflammatory breast cancer is occasionally diagnosed in men. These men tend to be older than women affected by inflammatory breast cancer.[2]

Even though the chances of having a rare disease like inflammatory breast cancer are extremely small, symptoms like these should never be ignored. A medical evaluation is necessary to rule out more common (and less serious) causes like simple breast infection, as well as other serious problems like Paget’s Disease of the breast (see “A New Kind of Breast Cancer?: Paget’s Disease“)

What to Do

If you have symptoms that persist for more than a few days, well-respected breast surgeon Dr. Susan Love recommends antibiotics and close watching for two weeks. If the problem is caused by a bacterial infection, the medication should result in noticeable improvement in 10-14 days. If the problem is caused by a viral infection, it won’t respond to the antibiotic so it will probably either a) get significantly worse or b) run its course and get much better in 10-14 days. Any of these outcomes is good news. On the other hand, if there is no change in the symptoms within 10 to 14 days with antibiotic treatment, you need to make an appointment with a breast specialist for a biopsy as soon as possible.

Diagnosis and Treatment

The changes that lead to a diagnosis of inflammatory breast cancer usually occur over a period of only a few weeks. It is likely that it has already spread to other parts of the body before any symptoms appear.

Mammograms are not usually effective in detecting inflammatory breast cancer. Even though an MRI exam might provide earlier diagnosis, this is not a realistic option for women without symptoms. A biopsy is needed for an accurate diagnosis. In addition, a diagnosis is more likely if the redness covers at least a third of the breast.[3]

Treatment is similar to the treatment for other invasive breast cancers – including chemotherapy, surgery, radiation, and hormonal therapy. The average survival for patients diagnosed with Stage III inflammatory breast cancer is a little less than five years and the average survival for patients diagnosed with Stage IV inflammatory breast cancer is just under 2 year.[4] Survival rates are significantly worse for African Americans diagnosed with inflammatory breast cancer, possibly because they tend to be diagnosed later.[5]

How Worried Should Women Be?

Inflammatory breast cancer is a rare disease, so the chances of your getting it are quite small. Awareness of what symptoms to look for and of how to go about having those symptoms evaluated is the most important defense against this and any disease.

Additional information about IBC can be found at:

• http://www.cancer.gov/types/breast/ibc-fact-sheet and
• www.ibcresearch.org

To separate fact from fiction on other Internet Health info, click here.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

1. Sosa A, Lei Z, Woodward WA et al.  Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US,  JAMA Network Open. 2022;5(2):e2148021.
2. Bertucci F, Ueno NT, Finetti P, et al. Gene expression profiles of inflammatory breast cancer: correlation with response to neoadjuvant chemotherapy and metastasis-free survival. Annals of Oncology 2014; 25(2):358-365.
3. National Cancer Institute. Inflammatory Breast Cancer. January 6, 2016. http://www.cancer.gov/types/breast/ibc-fact-sheet
4. Surveillance, Epidemiology, and End Results Database, National Cancer Institute, 2015.
5. Bertucci F, Ueno NT, Finetti P, et al. Gene expression profiles of inflammatory breast cancer: correlation with response to neoadjuvant chemotherapy and metastasis-free survival. Annals of Oncology 2014; 25(2):358-365.

Susan Dudley, PhD and Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

Thanks to the widespread use of screening mammography, many women are being diagnosed with breast cancer.  However, that has also resulted in what some experts consider an epidemic of women diagnosed with abnormal breast conditions that are not cancer or may never develop into invasive cancer. Some of these conditions are not at all dangerous, and others have survival rates near 99%; nevertheless, these diagnoses often sound very frightening. In fact, research shows that these women are often just as worried about whether they will survive as women with the much more dangerous, invasive forms of breast cancer.

There is a wide range of treatment for women with these “stage zero” conditions. Although mastectomies are almost never necessary or recommended by experts, many women undergo mastectomies nevertheless. Research suggests that this is especially likely in the South, Midwest, and Southwest parts of the United States, in certain types of medical facilities, and with older doctors.

Knowing the Facts Will Reduce the Fear

It can be extremely upsetting for a woman to learn that she has any condition that increases her breast cancer risk. Too often, such news leaves women feeling that they must rush into surgery. They agree to – or even insist upon – undergoing mastectomies that they do not really need, in hopes that it will increase their chances of survival. In fact, their chances of survival are already very high, and having a mastectomy will not make it higher.

The good news is that most women with “pre-cancerous” conditions or other non-cancerous breast conditions will never get invasive breast cancer. For example, only 1 in 12 breast lumps is cancerous, and 1 in 5 cases of micro-calcification (white spots seen on mammograms that alert doctors that follow-up diagnosis is needed) are related to cancer, so most women get good news after a breast biopsy. For many women, however, anxiety levels soar when they learn that they might possibly be at risk for breast cancer because of abnormal changes in their breasts.

This issue brief will describe two conditions that are often referred to as “stage zero breast cancer” as well as other non-cancerous abnormal breast conditions.

Ductal Carcinoma In Situ (DCIS)

In recent years, ductal carcinoma in situ (DCIS) has become one of the most commonly diagnosed breast conditions. It is often referred to as “stage zero breast cancer” or a “pre-cancer.” It is a non-invasive breast condition that is usually diagnosed on a mammogram when it is so small that it has not formed a lump. In DCIS, some of the cells lining the ducts (the parts of the breast that secrete milk) have developed abnormally, but the abnormality has not spread to other breast cells. DCIS is not painful or dangerous, but it sometimes develops into breast cancer in the future if it is not treated, and that breast cancer can spread and is therefore dangerous. That is why surgical removal of the abnormal cells, followed by radiation, is usually recommended.

What makes most cancers dangerous is that they are invasive, which means they are not restricted to one spot, but have spread to other cells within the organ where they arose. Once that happens, cancer can metastasize, which means that it spreads to other organs in the body.  Experts disagree on whether DCIS should be called “cancer” or “pre-cancer” but everyone agrees that it is not an invasive type of cancer and that DCIS cannot metastasize unless it first develops into invasive cancer.

The goal of treating invasive cancer while it is still confined to the breast is to prevent it from spreading to the lungs, bones, brain, or other parts of the body, where it can be fatal. Since DCIS is not an invasive cancer, it is even less of a threat than Stage 1 or Stage 2 breast cancer, which are the earliest types of invasive cancer.

Having DCIS means that a woman has an increased risk for developing invasive breast cancer in the future, unless she has treatment. Most women with DCIS will never develop invasive cancer whether they are treated or not, but it is impossible to predict which women with DCIS will develop cancer and which ones won’t.  That’s why treatment is recommended.  A woman with DCIS does not need all the same treatment as a woman diagnosed with invasive breast cancer, but she does need surgery to remove the DCIS, and radiation to ensure that any stray, abnormal cells are destroyed. This lowers the risk that the DCIS will recur or that invasive breast cancer will develop.  Some women also try hormone therapy such as tamoxifen or aromatase inhibitors to reduce their risk even further.

DCIS does not need to be treated immediately. A woman can spend a few weeks after her diagnosis to talk with her doctors, learn the facts about her treatment choices, and think about what is important to her before she chooses which kind of treatment to have.

For more information about DCIS, see our booklet.

Treatment Choices for DCIS

DCIS patients have three surgery choices. They are 1) lumpectomy 2) mastectomy or 3) mastectomy with breast reconstruction surgery. Most women with DCIS can choose lumpectomy.

Lumpectomy means that the surgeon removes only the cancer and some normal tissue around it. This kind of surgery keeps a woman’s breast intact – looking a lot like it did before surgery. Under most circumstances, mastectomy does not increase survival time for women with DCIS, and would only be considered under unusual circumstances, such as cases where the breast is very small or the area of DCIS is very large. For women who undergo mastectomy, reconstruction can replace the breast lost to cancer. However, there is some evidence that women with DCIS who undergo mastectomy do not live as long as those who undergo lumpectomy.

Radiation therapy is often recommended for many women with DCIS after lumpectomy. This type of treatment could prevent more DCIS or invasive cancer from developing in the same breast. However, DCIS patients who choose lumpectomy live just as long whether they undergo radiation or not. DCIS patients who undergo a single mastectomy or double mastectomy do not live any longer than DCIS patients who undergo lumpectomy.

Tamoxifen or another hormonal therapy is recommended for some women with DCIS to help prevent breast cancer. The benefit is that it can further decrease the risk of recurrence of DCIS or the development of invasive breast cancer. In the last few years, tamoxifen is sometimes recommended instead of surgery. However, these hormonal medicines can have potentially dangerous side effects, such as increased risk of endometrial cancer, severe circulatory problems, or stroke. In addition, hot flashes, vaginal dryness, abnormal vaginal bleeding, and a possibility of premature menopause are common for women who were not yet menopausal when they started treatment.

Active surveillance is gaining attention as an option for women with DCIS.  Active surveillance consists of regular mammography screening to make sure the DCIS does not develop into breast cancer.[1]

Unlike women with invasive breast cancer, women with DCIS do not usually undergo chemotherapy and they usually do not need to have their lymph nodes tested or removed. Since most DCIS will never become cancer, you should consider getting a second opinion if a doctor recommends either chemotherapy or lymph node removal for DCIS.

Experts now believe that most women with DCIS will never develop invasive breast cancer even if they receive no treatment for DCIS. But, if a woman with DCIS is relatively young and healthy, she is likely to choose lumpectomy with or without radiation so that she can put fears of breast cancer behind her.

Lobular Carcinoma In Situ (LCIS)

Lobular carcinoma in situ (LCIS) is also sometimes referred to as stage zero breast cancer. But we shouldn’t let the words “carcinoma” or “cancer” scare women. LCIS got its name many years ago, before doctors realized that it is not breast cancer at all.

Unlike breast cancer, LCIS does not form a tumor. Unlike DCIS, it does not form abnormal cells that can develop into invasive cancer. That is why no surgery is needed to remove LCIS. Instead, LCIS is one of several conditions that may indicate an increased risk for a woman to develop breast cancer in the future. Even though most women who have LCIS never develop breast cancer, a woman with LCIS should talk to her physician to evaluate all her risk factors and to set up a plan to monitor her breast health, such as regular mammograms. This will ensure that any changes in her breast health can be detected and evaluated very early.

How Is LCIS Different from Breast Cancer?

In LCIS, some of the cells lining the lobules (the parts of the breast that can make milk) have developed abnormally. LCIS is not cancer. It does not cause pain or produce a lump. In fact, by itself, LCIS is not a dangerous condition.

How Does LCIS Affect Breast Cancer Risk?

There is no way for doctors to predict whether a woman with LCIS will develop breast cancer in the future. Most won’t, but if they do, it could be in either breast (not just the one where the LCIS was found) and in any part of the breast (not just in the area near where the LCIS was discovered).

What Is the Treatment for LCIS?

LCIS has no symptoms, and is first suspected because of an abnormal mammogram. A biopsy is needed to confirm the diagnosis. After a diagnosis is made, no more surgery or other treatment is needed, even if the affected area is large.

The abnormally developing cells that make up LCIS are often spread around in more than one location in the breast. It may even be in several areas and both breasts. If LCIS is diagnosed in one breast, it is not necessary to search for it or biopsy the second breast or to try to locate each area of affected lobules. That’s because no treatment is necessary regardless of the spread or location.

Women diagnosed with LCIS may question why no treatment is necessary, but experts agree that LCIS is a condition that should be managed rather than a disease to be treated. You can think of it like being overweight, which is a condition that puts a person at risk for heart disease but is not itself heart disease – and people who are overweight do not always develop heart disease.

Women with LCIS who are especially worried and want to “do something” can consider a low calorie or low-fat diet, as well as an increase in fresh fruits and vegetables to reduce their risk of future breast cancer. Although the research is not conclusive, those kinds of dietary changes may reduce the risk of breast cancer, and also have the potential to prevent other diseases. Hormonal therapy (with a drug such as tamoxifen) is also sometimes recommended to reduce the risk of future breast cancer, although it has the potentially dangerous side effects mentioned earlier, such as increasing the risk of stroke and endometrial cancer, and can cause unpleasant symptoms such as hot flashes and vaginal dryness. However, if a woman is very worried and does not feel comfortable without treatment, hormonal therapy is a less radical prevention method than bilateral mastectomies.

Other Non-Cancerous Breast Conditions

Many women who find lumps on their breasts do not have cancer, DCIS, or LCIS. Non-cancerous lumps can be cysts that are filled with fluid, or fibroadenomas, which are smooth, and hard, often feeling like a marble under the skin. Thickened but harmless areas called pseudo-lumps also fall into this category. Cysts are sometimes but not always drained, but otherwise, these conditions usually require no further treatment. Fibrocystic breasts (also called mammary dysplasia, benign breast disease, or diffuse cystic mastopathy) feel bumpy or lumpy and sometimes painful. This condition used to be considered a pre-cancerous disease, but experts now realize that it is not a disease and does not increase the risk of breast cancer.

What About Mastectomy to Prevent Future Breast Cancer?

More than 20 years ago, when breast conditions like these were diagnosed, they were often treated with mastectomy, surgery which completely removes the affected breast. Sometimes a healthy second breast was also removed (prophylactic mastectomy), even when there was no sign of cancer or other abnormalities in the other breast.

Today, thanks to advances in scientists’ understanding of breast cancer and of these other conditions, along with the development of better diagnostic, surgical, and treatment techniques, mastectomy is often unnecessary. In fact, we now know that a less radical treatment (lumpectomy followed by radiation therapy for most DCIS or Stage 1 or Stage 2 cancers) or no treatment (for cysts, fibroadenomas, fibrocystic breasts, and LCIS) is just as effective.  The latest research indicates that women who undergo lumpectomy and radiation rather than mastectomy tend to live longer.[2] Except in unusual circumstances, mastectomy does not increase survival time for these conditions, and the risks of mastectomy usually outweigh any benefits.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

Related Content:
DCIS: Mostly good news
Vitamin D and breast cancer
BRCA1 and BRCA2 mutations: when your genes increase your cancer risk
Radiation Therapy for Ductal Carcinoma In Situ (DCIS)
Hormonal Therapy for Ductal Carcinoma In Situ (DCIS)

References

1. Esserman L, “When Less is Better, but Physicians are Afraid not to Intervene.” Journal of the American Medical Association: Internal Medicine 2016 May 31; doi: 10.1001/jamainternmed.2016.2257
2. Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA.Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer 2013 Apr 1;119(7):1402-11. doi: 10.1002/cncr.27795