There is little difference in survival rates for younger breast cancer patients who undergo lumpectomy rather than mastectomy, even though their tumors tend to be more aggressive and are typically diagnosed at a later stage than older women, according to results presented April 6 at the 23rd Annual Meeting of the American Society of Breast Surgeons in Las Vegas.
The study is one of largest to date on the impact of surgical approach on survival outcomes in younger patients, said lead author Christine Pestana, MD, Breast Surgical Oncology Fellow at Atrium Health, Levine Cancer Institute, Charlotte, NC.
Using the Young Women's Database at Levine Cancer Institute, the researchers performed a retrospective chart review of 591 subjects with non-metastatic invasive breast cancer diagnosed between 2010 and 2019 who received surgical intervention and were followed up to 67 months post-surgery. The mean patient age was 37.
They were stratified by hormone receptor (HR) and HER2 status, type of surgery, demographic information, as well as cancer stage, tumor grade, and the use of hormone and systemic therapy.
The mortality across all groups was 12 percent and the team found overall that treatment with mastectomy or lumpectomy had no impact on survival, and rates were similar across HR and HER2 subtypes. However, within the HR+/HER2- group, failure to comply with hormonal therapy when it was prescribed was associated with a higher risk of death. Black patients with triple-negative cancers also had higher mortality. However, no other factors examined were associated with lower survival.
"Younger women are increasingly being diagnosed with breast cancer, despite low rates overall, and a growing number are undergoing mastectomy and even prophylactic bilateral mastectomy rather than breast-conserving surgery," Pestana told a press briefing. "Studies like this show that lumpectomy, a far less aggressive approach with fewer potential complications and morbidity, is equally as effective as removing an entire breast."
Among the variables assessed for association with overall survival were age, race, BMI, disease stage, grade, presence of lymphovascular space invasion, extranodal extension, extent of surgery (breast conservation vs. mastectomy), presence and timing of chemotherapy (neoadjuvant, adjuvant, none), and presence of hormonal therapy (when appropriate).
In the HR+/HER2- group, 85.4 percent took anti-estrogen therapy, and multivariable analyses showed that only an absence of hormone therapy was significant, with a 2.9 increased risk of death for patients who did not take hormone therapy when compared to those using it.
Pestana believes many young women may be influenced by their age and equate an aggressive approach with better long-term survival. However, there is a greater risk of problems with mastectomies, such as infection, wound issues, chronic pain, and the need for subsequent multiple reconstructive procedures.
"A decision on breast cancer surgical treatment has many implications, and these women will live with them the rest of their lives," Pestana said.
Mastectomy rates are increasing in younger patients despite lack of data supporting improved survival, she noted. Younger patients have historically been excluded from breast cancer studies; however, diagnostic and treatment frameworks apply to them. Moreover, research has shown that many women have family histories and other breast cancer risk factors that were not identified prior to diagnosis.
"Breast cancer is a particularly difficult disease for younger women. The medical system should prioritize empowering cancer patients and those at risk with research, guidance, and information focusing on their specific age group," Pestana noted. "Patients may benefit from consulting with several doctors to get multiple perspectives. Peace of mind is an important consideration. Treatment decisions should be based on the nature of the tumor; but, ultimately, patients must be comfortable with their decision, and their doctors should support an informed choice.
"Studies specifically focusing on these patients would likely yield important information that may help physicians better understand, counsel, and treat these patients and help women in their decision-making," she concluded.
Kurt Samson is a contributing writer.
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