2011 Breast Cancer Symposium
SAN FRANCISCO — Recurrence and survival rates are similar after
breast-conservation surgery and mastectomy in women aged younger than 40 years
with breast cancer, according to two studies.
In a retrospective study of the medical records of 628 women aged 40
years and younger, Julliette Buckley, MD, a fellow in breast surgery at
Massachusetts General Hospital, and colleagues analyzed the rates of local
recurrence, distant recurrence and OS among those diagnosed with up to stage
III breast cancer between 1996 and 2008.
The rate of locoregional recurrence was 5.56% at 5 years and 12.11% at
10 years. There was no difference in the rate of locoregional occurrence
between the group of patients who underwent breast-conserving therapy and the
group of patients who underwent mastectomy: 7.34% vs. 7.4%.
“Prior studies have shown that younger women have a higher rate of
local recurrence after lumpectomy, but our study suggests that lumpectomy is a
safe option for young women,” Buckley said. “We believe that
awareness of the genetic risk of breast cancer, advances in screening for
breast cancer, and improvements in systemic and radiation therapy have
contributed to longer OS for young women with breast cancer.”
In another study, Usama Mahmood, MD, a fellow in radiation
oncology at The University of Texas MD Anderson Cancer Center, and colleagues
found that breast-conservation therapy results in similar survival outcomes
compared with mastectomy in younger women with early-stage breast cancer.
The researchers used the SEER database to analyze OS and cancer-specific
survival among 14,760 women aged 20 to 39 years who were diagnosed with
early-stage breast cancer. After controlling for variables, including
diagnosis, age, race/ethnicity, tumor grade, PR status, tumor size and lymph
node status, they found there was no difference in OS between the two groups.
Among those who underwent breast-conservation therapy, OS at 5, 10 and
15 years was 92.5%, 83.5% and 77%, respectively. Among those who underwent
mastectomy, OS at 5, 10 and 15 years was 91.9%, 83.6% and 79.1%, respectively.
“Our findings provide reassurance that breast-conservation therapy
leads to similar survival outcomes as mastectomy, even among younger women with
early-stage breast cancer,” Mahmood said. “Women should be counseled
appropriately regarding their treatment options and should not choose a
mastectomy based on an assumption of improved survival.”
For more information:
- Buckley J. #70. Presented at: 2011 Breast Cancer Symposium; Sept.
8-10; San Francisco.
It’s very important that we periodically revisit conventional
wisdom, and in this case, it is an important revisitation to the conventional
wisdom that young women with breast cancer need to have a mastectomy. There are
certainly differences in the biology of the disease in young women compared to
older women. But this contemporary theory reflects management that has likely
been influenced by newer modalities such as the use of breast MRI for
screening, and therefore better selection of patients who might better undergo
breast-conservation therapy compared to mastectomy. Also, a greater number of
women are being tested for BRCA to identify those at risk. It’s
reassuring to younger women that young age alone does not seem to mandate the
need for mastectomy. One needs to look at other variables, independent of age.
– Andrew D. Seidman, MD
Physician, Memorial Sloan-Kettering Cancer Center
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.