COMMENTARY | In January 2012, I had a mastectomy. It was a decision entered into with much pain and emotion. The option to have a lumpectomy was given to me, but I declined. CBC News in Canada reports that women who live in low-income areas have the highest rate of mastectomy. The report is based on clinical data, and it does not take into account why a woman would choose mastectomy over lumpectomy.
Standard radiation treatment
The most common radiation treatment is five consecutive days of radiation every week, for six to eight weeks. Patients like me, who live two hours from a treatment center, might want a different treatment option. You cannot drive yourself home from radiation -- it is unsafe because you will be too exhausted from the treatment to drive.
Women who live in rural areas may not have access to local radiation facilities. Travel time and time away from work, home, and a patient's support network may play a large role in the decision to forgo a lumpectomy and radiation in favor of a mastectomy.
Alternative to traditional radiation
It is the gold-standard of care to follow a lumpectomy with radiation treatment. Depending on the size of the tumor, alternatives to traditional radiation are available.
IORT brings a portable radiation unit into the operating room. I wish my situation gave me this option because I would have jumped on it -- unfortunately, it did not. Once the tumor is exposed, a protective plate is placed between the tumor and the chest wall. Then a concentrated beam of radiation is directed on the tumor and surrounding area. No further radiation treatments are required. This technology spares patients from skin burns associated with traditional radiation and it eliminates possible damage to the chest wall and lungs.
I discussed brachytherapy with doctors. Brachytherapy only had a 50 percent chance of success in my situation -- bummer. A balloon containing several rods of radioactive material is placed into the cavity formed by tumor removal. The rods deliver radiation internally to the tumor area over a few days. Like IORT, brachytherapy protects the skin, chest wall and lungs from radiation damage.
Deciding on mastectomy
Patients with large tumors or metastatic disease do not have the option of a lumpectomy. A bone scan and full-body CT scan showed no signs of my cancer spreading to other areas, but my tumor was 2.1 cm. This eliminated the choices of IORT or brachytherapy for me. I did not want to go through traditional radiation treatments so a mastectomy became my only option.
One final note on choosing a mastectomy; about 10 percent of women with breast cancer carry a mutation of the BRCA gene. For women with this gene mutation, the gold-standard for breast cancer surgery is a bilateral mastectomy (removal of both breasts.) Income and socio-economic status is not always the reason women choose a mastectomy.
Lynda Altman was diagnosed with breast cancer in November 2011. She writes a series for Yahoo! Shine called "My Battle With Breast Cancer."
- Tests & Procedures
- radiation treatment