Young Patients Are Served Equally Well by Lumpectomy or Mastectomy

Caroline Helwick

December 2011, Vol 2, No 7 - ASCO Breast Cancer Symposium


San Francisco, CA—Breast cancer in women under age 40 years is often considered a more aggressive disease than in older women, and this often leads clinicians to recommend mastectomy over breast-conserving therapy (BCT), that is, lumpectomy or radiation. However, 2 studies presented at the 2011 Breast Cancer Symposium suggest that younger age in itself is not a reason for mastectomy.

Andrew D. Seidman, MD, of Memorial Sloan-Kettering Cancer Center, who moderated a press briefing, commented, “This is an important revisitation of the conventional wisdom that young women who have breast cancer really need to have mastectomy.”

To determine the risk of recurrence “in the modern era of multimodal treatment,” Juliette M. Buckley, MD, Mas – sachusetts General Hospital, Boston, spearheaded a retrospective review of 628 young women (?40 years) diagnosed with stage I-III breast cancer.

The analysis showed that BCT did not result in a higher rate of locoregional or distant recurrence than mastectomy. On multivariate analysis, only tumor size >2 cm and positive lymph nodes were independent predictors of recurrence. Therefore, “lumpectomy is indeed a safe option for young women,” Dr Buckley concluded.

Other researchers at M.D. Anderson Cancer Center, Houston, analyzed the Surveillance, Epidemiology, and End Results database of 14,764 young women (?40 years) with early breast cancer. After adjusting for potential confounders, women who received BCT had no worse overall survival or breast cancer–specific survival than women who had mastectomy.

Dr Seidman advised that the type of surgery should no longer be considered a key issue. “We are starting to look beyond the usual prognostic factors, such as tumor size, grade and lymph node, estrogen-receptor, and HER2 status, and are moving into biological subtyping to obtain additional information regarding the risk of relapse,” he said.

Of note, in spite of equivalent survival for lumpectomy, several studies have shown that mastectomy rates are increasing across all age-groups, noted Rakesh Patel, MD, Western Radiation Oncology, El Camino, CA, who discussed the M.D. Anderson Cancer Center research. He attributed this to improved reconstruction options, use of preoperative magnetic resonance imaging, and identification of patients with genetic predispositions. “And all the factors have a greater influence in younger patients,” Dr Patel noted.