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Breast Cancer Does Not Mandate Mastectomy in Young

By: SUSAN LONDON, Hospitalist News Digital Network

09/07/11

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Young women with early breast cancer need not have a mastectomy instead of a breast-conserving

therapy if the rationale is based solely on their age, investigators concluded in a pair of retrospectivecohort studies being reported at the ASCO Breast Cancer Symposium.

In the studies, conducted among more than 15,000 women aged 40 years or younger having median

follow-up of about 6 years, rates of locoregional recurrence, overall survival, and breast cancerspecificsurvival were statistically indistinguishable from those who had breast conservation and theircounterparts who had mastectomy, according to data presented in a premeeting press briefing.

Collectively, the results suggest that contemporary management of breast cancer has helped to offset thepoorer outcomes historically associated with younger age at diagnosis, commented Dr. Andrew D.Seidman, moderator of the press briefing and a medical oncologist at the Memorial Sloan-KetteringCancer Center in New York.

Dr. Andrew DSeidman

"This is an important revisitation of the conventional wisdom that young women who have breastcancer really need to have mastectomy," he said. "There certainly are differences in the biology of the

disease in young women, compared to older women."

He suggested these new findings likely reflect changing influences on breast cancer management, such

as use of genetic testing to better identify women with deleterious mutations and possibly breast MRI.

"Its reassuring to younger women that simply young age alone does not seem to mandate the need formastectomy, and one needs to look at other variables independent of age," Dr. Seidman said. Thosevariables will include factors like multicentricity or multifocality, BRCA mutations, family history, and,


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not least, womens concerns about recurrence and second cancers.

Additionally, research is identifying biological subtypes of breast cancer that may be useful here, henoted. For example, among women with luminal type A breast cancer, emerging data suggest that

Oncotype DX recurrence score may help assess risk of local relapse.

The bottom line, he stressed, is that "if a woman is told, you need to have mastectomy because you areyoung, the discussion needs to go beyond that," and individualized decision making is essential.

In the first study, Dr. Julliette M. Buckley and her colleagues at Massachusetts General Hospital inBoston reviewed the medical records of 628 women aged 40 years or younger who received a diagnosisof breast cancer up to stage III between 1996 and 2008 and were treated at their institution.

The women had a median age of 37 years. Overall, 71% had breast-conserving therapy, according toDr. Buckley.

With a median follow-up of 72 months, the women had statistically indistinguishable rates oflocoregional recurrence with breast conservingtherapy vs. mastectomy. Rates of locoregional and

distant recurrence were 5.6% and 12% at 5 years, respectively, and 13% and 19% at 10 years. Rates ofdisease-free survival and overall survival were 82.5% and 93% at 5 years, respectively, and 87% and68.5% at 10 years.

The findings suggest "that lumpectomy is indeed a safe option for young women," concluded Dr.Buckley, a breast surgery fellow.

"We believe that awareness of the genetic risk of breast cancer, advances in the screening for breast

cancer, and improvements in systemic and radiation therapy have contributed to the longer overallsurvival for young women with breast cancer that we have demonstrated in this study," she said. "Wefeel that these results ... will give young women with breast cancer some reassurance if they choose to

have a lumpectomy."

In the second study, investigators led by Dr. Usama Mahmood of the University of Texas M.D.Anderson Cancer Center in Houston analyzed data from the Surveillance, Epidemiology, and EndResults database for 14,764 women 20-39 years old who received a diagnosis of early breast cancer

between 1990 and 2007. Overall, 45% received breast-conserving therapy. The median duration offollow-up was 5.7 years.

In multivariate analyses that adjusted for potential confounders (including year of diagnosis, age,

race/ethnicity, histology, grade, one vs. multiple regions of involvement, tumor size, number of positivelymph nodes, number of examined lymph nodes, estrogen receptor status, and progesterone receptor

status), women treated with breast-conserving therapy did not differ significantly from their counterpartstreated with mastectomy in terms of either overall survival (hazard ratio, 0.93; P = .16) or breast cancer

specific survival (hazard ratio, 0.93; P = .26).

The findings were similar in an additional analysis of a subset of 4,644 women from the two groupswho were matched for patient and tumor characteristics, according to Dr. Mahmood, a fellow in

radiation oncology, who did much of her search while at the University of Marylands GreenebaumCancer Center in Baltimore. In this analysis, women treated with breast-conserving therapy and theircounterparts treated with mastectomy again had similar 10-year overall survival (83.5% vs. 83.6%, P =

.99) and breast cancerspecific survival (85.5% vs. 85.5%, P = .88).

"We found similar survival with either breast-conserving therapy or mastectomy in the treatment ofyoung women with early-stage breast cancer," Dr. Mahmood concluded. "This just serves as a reminderthat women should be counseled appropriately regarding their treatment options and should not choose a

mastectomy based on an assumption of improved survival."


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Dr. Seidman, Dr. Buckley, and Dr. Mahmood reported that they had no relevant conflicts of interest.

Copyright 2012 International Medical News Group, LLC. All rights reserved.This page was printed from www.EHospitalistNews.com . For reprint inquires, call 877-652-5295, ext.

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