Lumpectomy Considered a Safe Option for Young Breast Cancer Patients

The results of two separate studies presented at the recent Multidisciplinary Breast Cancer Symposium in San Francisco indicate that a lumpectomy doesn’t carry a higher recurrence or mortality risk than mastectomy for young women with breast cancer.

Both studies of outcomes for women 40 and younger were presented at a press telebriefing in advance of presentation at the Multidisciplinary Breast Cancer Symposium. The moderator of the telebriefing, Andrew D. Seidman, MD, of Memorial Sloan-Kettering Cancer Center in New York City commented on these findings, saying, “The conventional wisdom has been that young women with breast cancer need a mastectomy”

Julliette M. Buckley, MD, of Massachusetts General Hospital in Boston, and colleagues reported that Loco-regional recurrence was nearly identical over a median six years of follow-up at 7.34% with breast conserving surgery (lumpectomy) and 7.40% with mastectomy (P=0.980) in a single-center study.

Dr. Buckley also reported that genetic risk awareness as well as use of MRI for screening younger women and improvements in systemic and radiation therapy have boosted survival for young women with breast cancer, giving them a good prognosis.

In her group’s study of 628 women diagnosed with breast cancer from 1996 through 2008, local recurrence rates overall were 5.6% at five years and 13% at 10 years.

Those rates were lower than in prior studies, Buckley’s group noted. She suggested that the data could help young women with breast cancer make a more informed choice, but its biggest impact will likely be in making them “feel safe and secure keeping their own breast” if they choose lumpectomy.

Dr Seidman agreed in the press briefing, saying,”The studies should be reassuring to younger women that young age alone does not seem to mandate the need for mastectomy. Other factors, such as BRCA mutation status, which neither study accounted for, should also play a role in the surgical decision.”

Usama Mahmood, MD, of the MD Anderson Cancer Center in Houston, and colleagues reported no significant differences between lumpectomy and mastectomy for early-stage breast cancer on any measure of overall or breast cancer-specific survival. Mahmood’s study included 14,760 women with early-stage breast cancer in the SEER database followed for a median of 5.7 years. After adjustment for all available tumor and patient characteristics, lumpectomy and mastectomy came out similar for overall survival and for breast cancer-specific survival.

In a matched-pair analysis of more than 4,600 women, the same was true for lumpectomy and mastectomy:

• 10-year overall survival rates were 83.5% versus 83.6% (P=0.99)

• 10-year breast cancer-specific survival rates were 85.5% for both groups (P=0.88)

“Women should be counseled appropriately regarding their treatment options and should not choose a mastectomy based on an assumption of improved survival,” Mahmood concluded in the briefing.

In Mahmood’s analysis of the national Surveillance, Epidemiology, and End Results (SEER) database from 1990 through 2007, 55% of women ages 20 to 39 opted for mastectomy.