Young women with nonmetastatic breast cancer have similar survival rates whether they are treated with mastectomy or lumpectomy, despite tumors that are typically more aggressive and discovered at a later stage compared to their older counterparts. These findings were from a recent study examining women with nonmetastatic breast cancer younger than age 40 presented by Pestana et al at the American Society of Breast Surgeons 23rd Annual Meeting. The study is among the largest on the impact of surgical approach on survival outcomes in a young patient population.
“The results are particularly significant because younger women are increasingly being diagnosed with breast cancer, despite low rates overall, and a growing number are undergoing mastectomy and even prophylactic bilateral mastectomy rather than breast-conserving surgery,” said lead study author Christine Pestana, MD, a breast surgical oncology fellow at Atrium Health, Levine Cancer Institute. “Studies like this show that lumpectomy—a far less aggressive approach with fewer potential complications and morbidity—is equally as effective as removing an entire breast.”
Dr. Pestana believes that many young women may be influenced by their age and equate an aggressive approach with better long-term survival. However, with mastectomy comes greater risk of problems such as infection, wound issues, chronic pain, and subsequent multiple reconstructive procedures.
“A decision on breast cancer surgical treatment has many implications, and these women will live with them the rest of their lives,” she said, noting that younger women with breast cancer may constitute a unique and underrepresented population. “Studies specifically focusing on these patients would likely yield important information that may help physicians better understand, counsel, and treat these patients and help women in their decision-making.”
Retrospective Study
The retrospective study examined 591 patients in the Young Women’s Database at Levine Cancer Institute who were diagnosed with cancer and treated surgically between 2010 and 2018. Patients were stratified based on hormone receptor and HER2 status. Along with type of surgery, demographic data and information on stage, tumor grade, and the use of hormonal and systemic therapy were collected. The mean patient age was 37, and women were followed up to 67 months postsurgery. The mortality across all groups was 12%.
Overall, treatment with mastectomy vs lumpectomy had no impact on survival. Additionally, survival was similar across hormone receptor and HER2 subtypes. However, within the hormone receptor–positive/HER2-negative group, failure to comply with hormonal therapy when it was prescribed was associated with a higher risk of death. Black patients with triple-negative disease also had higher mortality. No other factors examined were associated with lower survival.
Dr. Pestana noted that younger patients have historically been excluded from breast cancer studies, yet the diagnostic and treatment frameworks that emerge from this research are applied to them. Additionally, studies show that many women have family histories and other breast cancer risk factors that were not identified prior to diagnosis. Often, these factors flag patients for discussion of cancer surveillance and preventative therapy and can potentially lead to an earlier diagnosis.
“Breast cancer is a particularly difficult disease for younger women. The medical system should prioritize empowering… patients and those at risk with research, guidance, and information focusing on their specific age group,” she noted. “Patients may benefit from consulting with several doctors to take advantage of multiple perspectives. Peace of mind is an important consideration. Ultimately, patients must be comfortable with their decision, and their doctors should support an informed choice.”
