Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1,451 patients aged ≤40 years

• Published in: Breast cancer research and treatment Vol. 127; no. 1; pp. 207 - 215
• Main Authors: van der Sangen, Maurice J. C., van de Wiel, Fenneke M. M., Poortmans, Philip M. P., Tjan-Heijnen, Vivianne C. G., Nieuwenhuijzen, Grard A. P., Roumen, Rudi M. H., Ernst, Miranda F., Tutein Nolthenius-Puylaert, M. Cathelijne B. J. E., Voogd, Adri C.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.05.2011; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Adjuvant treatment; Adult; Age Factors; Analysis; Biological and medical sciences; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cancer research; Cancer therapies; Care and treatment; Cohort Studies; Combined Modality Therapy; Comparative studies; Epidemiology; Female; Gynecology. Andrology. Obstetrics; Humans; Lumpectomy; Mammary gland diseases; Mastectomy - standards; Mastectomy, Segmental - standards; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Recurrence; Surgical techniques; Survival Analysis; Tumors; Women; Young Adult; Young adults; Netherlands; Breast carcinoma; Prognosis; Local control; Mastectomy; Systemic treatment; Breast conservation; Survival; Breast disease; Conservation; Control; Efficiency; Surgery; Cohort study; Mammary gland; Public health; Human; Patient; Breast cancer; Malignant tumor; Long term; Mammary gland diseases; Treatment; Young adult; Breast; Early; Cancer
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-010-1110-x

To compare the effectiveness of breast-conserving therapy (BCT) and mastectomy, all women aged ≤40 years, treated for early-stage breast cancer in the southern part of the Netherlands between 1988 and 2005, were identified. A total of 562 patients underwent mastectomy and 889 patients received BCT. During follow-up, 23 patients treated with mastectomy and 135 patients treated with BCT developed a local relapse without previous or simultaneous evidence of distant disease. The local relapse risk for patients treated with mastectomy was 4.4% (95% confidence interval (CI) 2.4–6.4) at 5 years and reached a plateau after 6 years at 6.0% (95% CI 3.5–8.5). After BCT, the 5-, 10- and 15-year risks were 8.3% (95% CI 6.3–10.5), 18.4% (95% CI 15.0–21.8) and 28.2% (95% CI 23.0–33.4), respectively ( P  < 0.0001). Adjuvant systemic therapy following BCT reduced the 15-year local relapse risk from 32.9% (95% CI 26.7–39.1) to 16.1% (95% CI 9.1–23.1), ( P  = 0.0007). In conclusion, local tumor control in young patients with early-stage breast cancer is worse after BCT than after mastectomy. Adjuvant systemic therapy significantly improves local control following BCT and also for that reason it should be considered for most patients ≤40 years. Long-term follow-up is highly recommended for young patients after BCT, because even with systemic treatment an annual risk of local relapse of 1% remains up to 15 years after treatment.