Question: If I have chemotherapy before surgery, will that decrease the chance that I will need a mastectomy?
Answer: Yes, it does. And that's actually fairly new information that was developed over the past 4 or 5 years in European and North American centers, and most recently by a large randomized trial that was conducted by the National Surgical Adjuvant Breast Project and published in 1998. Again, in the past, tumor size was a frequent reason why women would have to undergo mastectomy if the tumor was so large that its removal would remove so much breast tissue that the cosmetic result would likely be poor.
Derived from our treatment of what we call locally advanced (or inoperable) breast cancer, we learned that women who received primary chemotherapy often demonstrated dramatic shrinkage of the tumor size. And in fact, in the NSABP trial, 80 percent of women had a reduction of tumor size of 50 percent or more using standard chemotherapy. And what we were also able to achieve is a significant increase in the number of women who could have a lumpectomy rather than mastectomy using this treatment sequence, instead of the more traditional surgery followed by chemotherapy. Using this sequence, we also found that survival was identical to the more routine sequence; in other words, it is perfectly safe to receive chemotherapy up front, and then, if possible, to do a lumpectomy rather than a mastectomy for the treatment of the cancer after chemotherapy.
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