Equivalent Survival With Mastectomy or Breast-conserving Surgery Plus Radiation in Young Women Aged < 40 Years With Early-Stage Breast Cancer: A National Registry-based Stage-by-Stage Comparison

Abstract

Introduction/Background Studies have shown that young patients with early-stage breast cancer (BC) are increasingly getting mastectomy instead of breast conserving therapy (BCT) consisting of lumpectomy and radiation. We examined the difference between outcomes in young women (age<40) treated with BCT versus mastectomy. Materials and Methods The Surveillance, Epidemiology, and End Results database was queried for women <40 years of age with stage I–II invasive BC treated with surgery from 1998–2003. Breast cancer specific survival (BCSS) and overall survival (OS) were evaluated by Kaplan-Meier survival analysis and the log–rank test between treatment types. Results Of the 7665 women, 3249 patients received BCT, while 2627 patients had mastectomy and no radiation. When separated by stage (I, IIA, and IIB), with median follow-up of 111 months, the BCT and mastectomy only groups showed no statistically significant differences in the BCSS and OS. Overall, age group 35–39 (66% of total) was associated with better 10-year BCSS (88%) and OS (86.1%) compared to younger patients aged 20–34 (34% of total), who had 10-year BCSS and OS of 84.1% and 82.3%, respectively (P<0.001 for both BCSS and OS). However, when patients of each age group were further subdivided by stages, the BCT group continued to show non-inferior BCSS and OS compared to the mastectomy group in all of the subgroups. Conclusion Our study suggests that while young age may be a poor prognostic factor for BC, there is no evidence that these patients have better outcome with mastectomy over BCT.

Evaluation of recurrence patterns and survival in modern series of young women with breast cancer

“…Although prior publications have examined surgical choice in young women with mixed results (Table ), there is a growing body of evidence that there is no difference in disease‐free survival or overall survival between operations . Some studies have documented an increased risk of LRR for patients who select BCS vs mastectomy, but this was not seen in our results.…”

Comparison of breast‐conserving therapy vs mastectomy in women under age 40: National trends and potential survival implications

“…Specifically studying patients under age 40, Donovan et al also reported a 10‐year overall survival disadvantage in unilateral mastectomy patients compared to BCT or bilateral mastectomy (77% vs 85% vs 83%; P < 0.02). However, Vila et al and Ye et al report no survival difference between BCT and mastectomy in women under 40.…”

“…17 Rates of bilateral mastectomy have increased despite studies showing a low risk of contralateral breast cancer (0.25%-1.25% annually 18 ) and no consistent literature showing survival benefits. 16,[19][20][21] Most survival studies have also not focused on the younger patients who are driving this trend reversal.…”

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

“…In recent years, several large retrospective analyses of contemporary data have suggested the stage‐adjusted superiority of BCS over mastectomy in early breast cancer in terms of breast cancer‐specific survival and overall survival. Other publications have focused on young women or triple‐negative breast cancer, with the results indicating that BCS is at least as good as mastectomy in terms of survival outcomes. This interesting finding has led some authors to question whether mastectomy without RT should be offered at all as a treatment alternative for early breast cancer, or whether it is time to abandon the ‘mastectomy myth’.…”