Can you talk about how attitudes toward mastectomies have changed in the last decade?

Well I think we have certainly changed the attitude toward mastectomy a lot in the last decade. It used to be that we felt like you had to cut the breast off because it was the only way to prevent it from spreading. And now that we have realized that breast cancer has been there eight to ten years by the time we come around it and rushing in and cutting the breast off is not what is going to save somebody.

We have realized that lumpectomy and radiation are equal. It is interesting, though, that in spite of the fact that all the data shows that they are equal, there are still many surgeons in this country who are recommending mastectomies and I am still hearing of many patients who are getting mastectomies because they somehow have the idea that that is a better, more aggressive treatment.

When you do a mastectomy you never get all the breast tissue and so there still is a local recurrence rate of about five to ten percent in the scar. If you do a lumpectomy and radiation there is a local recurrence rate in the breast of about five to ten percent. So they are equal in terms of preventing breast cancer from coming back in the breast.

They are also equal in terms of preventing cancer from coming back anywhere else in the body because most cancers have been there eight to ten years and those cells are out by the time you get there. So either your immune system is going to take care of them or the chemo or the hormones will take care of them. But what surgery you do is not going to make a difference on whether you live or die.