A recent study has shown that mastectomy and breast conserving therapy (BCT) consisting of lumpectomy and radiotherapy (RT) have equivalent survival outcomes for young women with early-stage breast cancer (Clin Breast Cancer [published online ahead of print April 2, 2015]. doi: 10.1016/j.clbc.2015.03.012).
The BCT group had a 10-year breast cancer-specific survival (BCSS) rate of 87.7% and an overall survival (OS) rate of 85.9% compared with rates of 85.4% and 83.5%, respectively, in the mastectomy-only group (P5.009 and .01, respectively, for BCSS and OS). In an analysis of patients from both treatment groups combined, those aged 35 to 39 years had significantly better 10-year BCSS and OS rates (88% and 84%, respectively) compared with patients aged 20 to 34 years (86% and 82%, respectively).
When stratified by stage of disease (I, IIA, and IIB), there were no differences noted with regard to BCSS,
OS, or non-BCSS between the 2 treatment groups.. When the patients were stratified by
disease stage and age, the only group among whom a difference in treatment (BCT vs mastectomy without RT) was found to influence survival was those patients aged 20 to 34 years with stage IIB disease. In this group of patients, those undergoing mastectomy only had a significantly inferior 10-year BCSS and OS rate versus the BCT group (P5.004 and .002 for BCSS and OS, respectively).
“Our study, along with prior data, provides convincing evidence that BCT is a safe and effective alternative for patients with early-stage breast cancer, even in patients under the age of 40,” says lead author Jason Ye, MD, chief resident of radiation oncology at Weill Cornell. Medical Center in New York City.“This is in contrast to the current trend of an increase in the rate of mastectomies.”
These findings are of interest because there is a trend in the United States for young women to undergo a mastectomy over BCT. A recent registry study of women with breast cancer who were aged younger than 46 years demonstrated that between 2003 and 2010, treatment with lumpectomy decreased from 61% to 49%, whereas the rate of bilateral mastectomy increased from 9% to 24%, and the unilateral mastectomy rate remained steady (J Am Coll Surg. 2014;219:19-28).