Breast-Conserving Surgery Recommended For Younger Women With Breast Cancer

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Data indicates that BCS and WBRT have similar outcomes and OS rates as mastectomy for younger patients.
Data indicates that BCS and WBRT have similar outcomes and OS rates as mastectomy for younger patients.

For women who are 40 years and younger with breast cancer who undergo breast conserving surgery (BCS), overall outcomes and prognosis have significantly improved over time, according to a report published in the British Journal of Surgery.

Young women with breast cancer are often treated with extensive and radical therapies such as mastectomies due to significantly worse prognoses and fears of locoregional relapse. A recently conducted meta-analysis, however, provides evidence that BCS and whole-breast radiotherapy (WBRT) have similar outcomes and overall survival rates as mastectomy.

In this single-center cohort study, 1331 young women with early stage breast cancer who underwent BCS followed by WBRT were evaluated over a median follow-up of 9.3 years.

Study patients were assigned into three arms based on tertiles in accordance to their dates of diagnosis: 1997-2002, 2003-2005, and 2006-2010. Overall, there were 114 local recurrences, 289 breast cancer-related events, and 138 deaths.

The risk of local recurrence (hazard ratio [HR], 0.93; 95% CI, 0.87-1.00), any breast cancer-related event (HR, 0.94; 95% CI, 0.91-0.98), and death (HR, 0.89; 95% CI, 0.83-0.94) decreased with each year of diagnosis.

The risk of locoregional recurrence was 1.42, 0.85, and 0.48 per 100 person-years in the in the first tertile, second tertile, and third tertile groups, respectively (P =.028).

The risk of any breast cancer related event was 3.01, 2.52, and 2.07 per 100 person-years for the first, second, and third groups, respectively (P =.004).

The risk of death was 1.59, 1.22, and 0.64 per 100 person-years for the first, second, and third groups, respectively (P =.003).

Significant improvements in the risk of recurrence, death, or any breast cancer-related event that occurred after 2005 were likely due to the major advancements in molecular subtype classification of breast cancer and the routine implementation of trastuzumab.

The study authors conclude that “whenever technically feasible, and after thorough preoperative evaluation, BCS should also be the first option in young patients with breast cancer, at least when genetic risk has not been demonstrated.”

Reference

1. Botteri E, Veronesi P, Vila J, et al. Improved prognosis of young patients with breast cancer undergoing breast-conserving surgery [published online August 9, 2017]. Br J Surg. doi: 10.1002/bjs.10658

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