Breast-Conserving Therapy Effective in Young Women with Breast Cancer

Two studies presented at the 2011 Breast Cancer Symposium provide evidence that breast-conserving therapy (lumpectomy plus radiation therapy) is as effective as mastectomy for young women with early-stage breast cancer. ?

Surgery for early-stage breast cancer may consist of mastectomy or lumpectomy. A?mastectomy involves removal of the entire breast, whereas a?lumpectomy?involves removal of the cancer and some surrounding tissue. A lumpectomy is usually followed by radiation therapy in order to reduce the risk of cancer recurrence in or near the breast. The combination of lumpectomy and radiation therapy is referred to as breast-conserving therapy. ?

Studies have indicated that mastectomy and breast-conserving therapy produce similar long-term survival among women with early-stage breast cancer. Some research has suggested, however, that young women may have a higher risk of breast cancer recurrence than older women after breast-conserving therapy. Concerns about recurrence risk may be contributing to the increasing use of mastectomy among young women.?

Two studies that will be presented at the 2011 Breast Cancer Symposium explore whether type of surgery affects outcomes among young women with breast cancer. The first study involved 628 women age 40 and younger who were treated for early-stage breast cancer at Massachusetts General Hospital.[1] ?

Risk of a local breast cancer recurrence (a recurrence in or near the breast) did not vary significantly by type of surgery. By five years, the risk of a local breast cancer recurrence was 4.6% among women treated with breast-conserving therapy and 8.5% among women treated with mastectomy. By ten years, the risk was 13.3% among women treated with breast-conserving therapy and 10.8% among women treated with mastectomy. ?

The second study collected information from a large national database about more than 14,000 breast cancer patients under the age of 40. [2] After accounting for patient and tumor characteristics, breast-conserving therapy and mastectomy produced similar overall survival. Ten-year overall survival was 83.5% among women treated with breast-conserving therapy and 83.6% among women treated with mastectomy.?

Together, these studies suggest that mastectomy and breast-conserving therapy produce similar outcomes among young women with early-stage breast cancer. Young women may wish to take this information into account when making decisions about breast cancer treatment.?

References: ??

[1] Buckley JM, Coopey S, Samphao S et al. Recurrence rates and long-term survival in women diagnosed with breast cancer at age 40 and younger. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 70.?

[2] Mahmood U, Morris CG, Neuner GA et al. Equivalent survival with breast-conservation therapy or mastectomy in the management of young women with early-stage breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 85.?

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Breast-Conserving Therapy May Outperform Mastectomy Alone for Women with Early-Stage Triple-Negative Breast Cancers

For women with early-stage triple-negative breast cancer, treatment with breast-conserving surgery plus radiation therapy may result in fewer cancer recurrences in or near the breast than mastectomy without radiation therapy. These results were published in the Journal of Clinical Oncology.???

Breast cancers that are estrogen receptor-negative, progesterone receptor-negative, and HER2-negative are called triple-negative breast cancers. Triple-negative breast cancers tend to be more aggressive than other breast cancers and have fewer treatment options.???

For women with small breast cancers that have not spread to the lymph nodes, treatment often includes breast-conserving surgery (lumpectomy) plus radiation therapy or mastectomy (removal of the entire breast) without radiation therapy. These two approaches are generally thought to produce similar outcomes, but it’s possible that for certain subtypes of breast cancer one approach may be more effective than the other.?????

To compare breast-conserving therapy (lumpectomy plus radiation therapy) to mastectomy among women with early-stage (T1-2N0) triple-negative breast cancers, researchers evaluated information from 468 patients. The group was fairly evenly split in terms of how many had been treated with breast-conserving therapy and how many had been treated with mastectomy without radiation therapy.???

Study participants were followed for a median of 7 years. One of the outcomes of interest was locoregional recurrence. This refers to a recurrence of the cancer in the breast, chest wall, or nearby lymph nodes.???

Five-year survival without a locoregional recurrence was 96% among women treated with breast-conserving surgery and 90% among women treated with mastectomy without radiation therapy. In other words, women treated with breast-conserving therapy had a lower risk of recurrence in the breast, chest wall, or lymph nodes than women treated with mastectomy without radiation therapy.?At the time of the analysis, overall survival was similar in the two groups.?

Although additional studies are needed, it’s possible that adding radiation therapy may improve outcomes among women who undergo mastectomy for early-stage, triple-negative breast cancer. In the current study, the risk of recurrence within or near the breast was lower among women treated with breast-conserving therapy (lumpectomy plus radiation therapy) than among women treated with mastectomy without radiation therapy.????

Reference: Abdulkarim BS, Cuartero J, Hanson J et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. Journal of Clinical Oncology. Early online publication June 13, 2011.?

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