Surgery Choices for Young Women
The conventional wisdom used to be that breast cancer in young women was likely to be a more aggressive disease and that mastectomies were the safer choice for them. The mastectomy choice, presumably, was based on concern about local recurrence as well as worry about longterm side effects of radiation therapy (as in, if you are 70 when you receive radiation, who cares about something that might happen 20 years later). The theories about more aggressive disease have been disproven some time agao, and we now know that, stage for stage, breast cancer is very similar in women of whatever age. This recent article from the Bulletin of the NCI takes on the other question of surgical choice:
For Young Women, Breast Conserving Surgery May Be Acceptable Alternative to Mastectomy
Women under age 40 who had breast-conserving surgery (BCS) did not have higher rates of local recurrence or poorer overall survival compared with women who underwent mastectomy, according to results from two retrospective studies. Young age at diagnosis is thought to be a risk factor for disease recurrence, and many young women with breast cancer choose mastectomy for treatment.
The research was presented at the 2011 American Society of Clinical Oncology Breast Cancer Symposium 40 in San Francisco. "These studies support [the idea] that breast conserving surgery with lumpectomy and radiation is an excellent option for young women, and may be the preferred approach," commented Dr. Jo Anne Zujewski, head of Breast Cancer Therapeutics in NCI's Division of Cancer Treatment and Diagnosis 41, who was not involved in the research.
In the first study 42, researchers led by Dr. Julliette Buckley of Massachusetts General Hospital reviewed the medical records of 628 young women with stage I to stage III breast cancer treated at their hospital between 1996 and 2008. The median follow-up time after treatment was 6 years. During the study period, 7.1 percent of women who had breast conserving therapy and 7.5 percent of women who underwent mastectomy had a local recurrence—a difference that was not statistically significant.
The local recurrence rates seen in this study are lower than in previous studies, stated the researchers. These new results suggest "that lumpectomy is indeed a safe option for young women," said Dr. Buckley during a press briefing. "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 overall survival for young women with breast cancer that we have demonstrated," she explained.
In the second study 43, investigators led by Dr. Usama Mahmood of the University of Texas M. D. Anderson Cancer Center examined data from NCI's Surveillance, Epidemiology, and End Results 44 database for 14,760 women between the ages of 20 and 39 who were diagnosed with stage I or stage II breast cancer between 1990 and 2007. All patients who received BCS underwent radiation therapy. The 10-year overall survival rate was virtually identical between the two groups: 83.5 percent for women who had BCS and 83.6 percent for women who had mastectomy.
"We found similar survival with either breast conservation therapy or mastectomy in the treatment of young women with early-stage breast cancer," said Dr. Mahmood. "This serves as a reminder that women should be counseled appropriately regarding their treatment options and should not choose mastectomy based on an assumption of improved survival."
Dr. Andrew Seidman, of Memorial Sloan-Kettering Cancer Center, who moderated the press conference, added: "It's very important that we periodically revisit conventional wisdom, and...this is an important revisitation of the conventional wisdom that young women who have breast cancer really need to have mastectomy."
Excerpted from: http://www.cancer.gov/ncicancerbulletin/092011