Early stage breast cancer means cancer cells are growing in the breast. This tool is for women considering mastectomy or lumpectomy with radiation. After either option you may have other treatments like hormones, chemotherapy, more surgery or radiation.

You will likely be asleep for either surgery. After either surgery you may have checkups and mammograms every year or more often if you get other treatments.

Patient Questions Mastectomy Lumpectomy with radiation
What does the treatment involve? You will have surgery to remove the whole breast. You may also have lymph nodes removed from your armpit. You may be in the hospital at least 1 day. Tubes will be inserted to drain fluid for up to 2 weeks. You will have surgery to remove the cancer lump and some surrounding tissue. You may also have lymph nodes removed from your armpit. You may go home the same day or the next day. After you heal, you will get radiation treatment for 3 to 6 weeks.
Will I need another surgery? You may choose to have a surgery to create what looks like a breast. This is done using an implant, or fat or skin from another part of your body. You may need another surgery if there are signs of cancer at the edges of the tissue that was removed.
Will I die?

Of 100 women, about:

  • 66 to 80 (66% to 80%) may live 10 years or more
  • 50 (50%) may live 20 years or more

Of 100 women, about:

  • 65 to 83 (65% to 83%) may live 10 years or more
  • 44 to 50 (44% to 50%) may live 20 years or more
Will my cancer come back (anywhere)?

Of 100 women, cancer may come back in about:

  • 12 to 34 (12% to 34%) within 10 years
  • 30 (30%) within 20 years

Of 100 women, cancer may come back in about:

  • 20 to 39 (20% to 39%) within 10 years
  • 29 to 36 (29% to 36%) within 20 years
What are the risks?

Of 100 women, about:

  • 4 to 8 (4% to 8%) may have skin die
  • 5 (5%) may have an infection
  • 1 (1%) may have a blood clot in the lung or leg
  • Risks like death, heart attack, stroke, or the wound opening are rare.

Surgery or radiation in the armpit may cause swelling, pain or numbness in the armpit or arm.

Of 100 women, about:

  • 2 (2%) may have an infection
  • Risks like stroke, a blood clot, or the wound opening are rare.

Radiation may cause skin changes, like darker or thicker skin but the changes usually go away over time. A new cancer from the radiation is rare.

Surgery or radiation in the armpit may cause swelling, pain or numbness in the armpit or arm.
What are the side effects? You may have pain, numbness, and swelling after surgery. You may see and feel a scar. You may have pain, numbness, and swelling after surgery. You may have peeling skin, have trouble breastfeeding with the treated breast, or feel tired after radiation.
How long does it take to recover? Many women return to work 3 to 6 weeks after surgery. Many women return to work 2 days to 2 weeks after surgery.

This patient decision aid (Early-stage Breast Cancer: Surgery Options) was created by the EBSCO Health Innovations and Evidence-Based Medicine Development Team (Brian S. Alper, MD, MSPH, FAAFP, FAMIA; Martin Mayer, DMSc, MS, PA-C; Eric Manheimer, PhD; Bonnie Johnson, MBA; Khalid Shahin, BA). Review for clinical accuracy and patient-friendly readability was provided by DynaMed Shared Decisions reviewers and editors (Susan Troyan, MD, FACS; Joseph S. Wislar, MS; Ryan Kelly, MS). Translation to Arabic was provided and reviewed by Fatima Al Hannan, Faye Al Khalifa, Julie Sprakel, RGN, MSc, FFNMRCSI, PhD and Haitham El-Baghdady, MD, MHA. The currency and accuracy of the content of this patient decision aid is maintained with a systematic process of:

  1. Scoping the patient questions with a clear specification of population, options, and outcomes of interest, informed by systematic surveys of people who may face this decision
  2. Systematically searching for the best available evidence to answer the scoped patient questions using DynaMed, PubMed with limiters for systematic reviews, PubMed with limiters for original research reports, and citation tracing
  3. Critically appraising articles which meet inclusion criteria for results and certainty of those results with consideration of risk of bias, directness, consistency and precision (based on GRADE Working Group methodology)
  4. Selecting the best available method of synthesis of evidence results based on certainty of evidence, magnitude of important differences, and expected patient perception
  5. Synthesizing evidence results to provide the best answer to represent the body of evidence
  6. Translating the summary of findings (synthesized evidence results) to patient-friendly language and presentation
  7. Confirming that patient-friendly presentation accurately represents the evidence synthesis
  8. Reviewing all feedback from clinical review, surveys of people who may face this decision, and feedback from users of the decision aid to revise content at any of the prior steps as warranted (and continue through subsequent steps)
  9. Continuously repeating the systematic searches and repeating subsequent steps as warranted

The evidence review for this patient decision aid was first completed on October 1, 2019 and last updated on April 8, 2020. There were 307 articles screened through systematic searches and 36 articles included for critical appraisal. References providing the greatest contribution to this decision aid include:

  1. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Locoregional Therapy for Early and Locally Advanced Breast Cancer; [updated 2019 Nov 4, cited 2019 Nov 14]. Available from https://www.dynamed.com/management/locoregional-therapy-for-early-and-locally-advanced-breast-cancer. Registration and login required.
  2. Chen Y, Jiang L, Gao B, Cheng ZY, Jin J, Yang KH. Survival and disease-free benefits with mastectomy versus breast conservation therapy for early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2016 Jun;157(3):517-25. PubMed
  3. Members of the Breast Cancer Disease Site Group. Surgical management of early stage invasive breast cancer. Brackstone M, Tey R, reviewers. Toronto (ON): Cancer Care Ontario; 2011 Sep 15 [Endorsed 2010 Nov 19]. Program in Evidence-based Care Evidence-Based Series No.: 1-1 Version 3. EDUCATION AND INFORMATION 2015. CCO Sep 2011
  4. Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol. 2005 Jun;28(3):289-94. PubMed
  5. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med. 1995 Nov 30;333(22):1444-55. PubMed
  6. Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. JAMA. 2014 Sep 3;312(9):902 PubMed
  7. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007 May245(5):665-71 PubMed
  8. Mota BS, Riera R, Ricci MD, Barrett J, de Castria TB, Atallah ÁN, Bevilacqua JL. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database SystRev. 2016 Nov 29;11:CD008932. PubMed