Appropriate to offer a choice of either breast conserving surgery followed by radiotherapy, or a mastectomy to patients diagnosed with early breast cancer, as these treatments are equally effective in terms of survival.
Strong evidence from large international trials has shown that breast conserving surgery followed by radiotherapy is as effective as mastectomy for most women with early breast cancer (defined as invasive cancer that is contained in the breast, or has spread to lymph nodes in the breast or armpit, but not to other parts of the body). This means that for most women, the overall survival rate is the same after either treatment.
Mastectomy rates vary across demographic and geographic groups in Australia with higher rates of mastectomy in non-metropolitan areas, especially outer regional and more remote locations, and in lower socio-economic areas.
Value to patients
Discussing the different surgical options for women with early breast cancer and offering a choice of either breast conserving surgery followed by radiotherapy, or mastectomy is important to support informed decision-making.
Australian Institute of Health and Welfare 2015. Breast cancer in young women: key facts about breast cancer in women in their 20s and 30s. Cancer series no. 96. Cat. no. CAN 94. Canberra: AIHW.
Hamelinck VC, Bastiaannet E, Pieterse AH, et al. Patients' preferences for surgical and adjuvant systemic treatment in early breast cancer: a systematic review. Cancer Treatment Reviews. 2014;40(8):1005-18.
Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncology. 2012;13(4):412-9.
Roder D, Zorbas H, Kollias J, et al. Factors predictive of treatment by Australian breast surgeons of invasive female breast cancer by mastectomy rather than breast conserving surgery. Asian Pacific Journal of Cancer Prevention. 2013;14(1):539-45.
Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast. 2015;24(3):175-81.