Choosing lumpectomy instead of mastectomy as breast cancer treatment does not reduce survival in young women, according to recent findings. A retrospective chart review of nearly 600 women younger than 40 years with nonmetastatic invasive breast cancer found that patients who underwent breast-conserving therapy, which includes tumor removal surgery plus radiation, had comparable survival to those who had full breast removal.
The finding (Abstract 1148289) was presented April 6 at the American Society of Breast Surgeons (ASBrS) 2022 annual meeting.
Women who are diagnosed at a younger age tend to have more aggressive cancers discovered at a later stage than their older counterparts. “Despite a lack of data showing improved survival, a trend towards mastectomy in young women persists,” said Christine Pestana, MD, Breast Surgical Oncology fellow at Atrium Health, Levine Cancer Institute, Winston-Salem, NC, the study’s lead author. However, based on a large body of literature showing that the two techniques have comparable survival, the ASBrS Consensus Group recommends breast conservation in appropriate candidates with early-stage breast cancer. Generally, mastectomy has a higher risk of complications than breast conservation, including wound infection, bleeding, and chronic pain.
Her group reviewed a database of 591 women younger than 40 years who underwent surgery for breast cancer between 2010 and 2019 at Levine Cancer Institute. Patients were stratified based on hormone receptor (HR) and HER2 status. As expected, most patients underwent mastectomy, with only 35% opting for breast-conserving surgery. Mortality across all groups was 12% up to 67 months after surgery. Compliance with hormonal therapy in the HR-positive group was associated with improved survival, and Black race was associated with worse survival in patients with triple-negative cancers. However, treatment with mastectomy versus lumpectomy had no effect on survival.
The data highlights the importance of counseling patients regarding outcomes and attempts to reduce unnecessary morbidity from more extensive surgical procedures, said Dr. Pestana.
The primary issue in women diagnosed younger, however, is a higher risk of genetic predisposition to cancer, noted Richard J. Bleicher, MD, Professor, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, via email. For this reason, these patients are routinely sent for genetic counseling, to determine if they have a deleterious genetic mutation.
“If they do, then they need to be counseled about a series of risks, including an elevated risk of breast cancer in their other breast and the risk of developing other malignancies,” according to Dr. Bleicher. “And so, because their other breast is at risk, for many of them removing the breast in question via mastectomy as well as the other breast prophylactically is an option that many choose. For women who have a genetic predisposition, breast conservation is also still an option, but these women are typically screened after their surgery more intensively with alternating mammograms and breast magnetic resonance imaging to ensure that another cancer doesn’t develop.”
Dr. Pestana had no disclosures to report.
Dr. Bleicher is a consultant for Elucent Medical.
