Some researchers say too many mastectomies are being performed; despite a solid body of research indicating the procedure is not always necessary, and despite guidelines issued by the National Cancer Institute and other major medical associations. These guidelines state the chances of survival for women with early-stage breast cancer are just as good with lumpectomy followed by radiation therapy.

At the recent meeting of the American Society of Clinical Oncologists in Los Angeles, one researcher drew renewed attention to this issue. Monica Morrow, MD, a breast cancer expert and professor at Northwestern University Medical School, presented evidence thousands of women could be spared mastectomies every year.

About 65 percent of breast cancers in American women are diagnosed at an early stage. In fact, as many as three-quarters of these women with early-stage breast cancer qualify for lumpectomies. But fewer than half will choose to have the breast-conserving surgery. "In some women, a total breast removal is a good choice. But the other 75 percent are not sacrificing their lives by just removing the tumor," said Dr. Morrow.

In a study published in the March 1998 issue of the Journal of American College of Surgeons, Dr. Morrow and her colleagues set out to determine the reason why mastectomy rates were so high. After studying 432 patients with early-stage breast cancer, Dr. Morrow found that when patients eligible for lumpectomy -- also called breast conservation therapy (BCT) -- were offered a choice, 81 percent chose BCT. Only 97 of the 432 patients were found to be ineligible for BCT because of specific medical reasons, including previous radiation therapy of that breast; multiple tumors in different areas of the breast; first or second trimester pregnancy at the time of diagnosis; or certain diseases of blood vessels that magnify the side effects of radiation therapy. Dr. Morrow concluded that in the majority of cases, there was no medical rationale for not prescribing BCT.

Dr. Morrow believes the overuse of mastectomies stems from a century-old concept that the best way to cure cancer is by cutting it out, using a surgical procedure. She believes such a concept is an outdated one, given what studies have shown about the effectiveness of newer, less radical treatment options.

Eight years ago, the National Cancer Institute issued its recommendations on treatment of early-stage breast cancer following a two-day conference. The panel of health care professionals and public representatives concluded, "Breast conservation treatment is an appropriate method of primary therapy for the majority of women with stage I or II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary [node] dissection while preserving the breast."

Backing up its recommendations, the panel noted five clinical trials involving 1,447 women who had breast conservation surgery and breast irradiation, versus 1,407 women who had a mastectomy. The results demonstrated mastectomy and lumpectomy are equally effective in terms of the patient's overall chances of survival.