This article is more than 5 years old. Information may no longer be current.
Breast cancer outcomes for young women who choose conservative treatment improve over time
Click Here to Manage Email Alerts
Outcomes for young women with breast cancer who underwent conservative treatment improved significantly over time, according to results of a retrospective analysis conducted in Italy.
These data could help physicians and their patients make more informed decisions about appropriate surgical treatment, researchers wrote.
“Breast cancer in young women has worse prognosis and greater likelihood of underlying hereditary genetic abnormalities than breast cancer in older women,” Oreste Gentilini, MD, head of the breast surgery unit at San Raffaele Research and University Hospital in Italy, and colleagues wrote. “The emotional challenges and the lack of clear data on the efficacy of different treatment strategies often drive both patient and physician to opt for the most radical and extensive treatments available.”
In light of improved diagnostic ability, better classification of breast cancer molecular subtypes and the introduction of more effective systemic therapies, Gentilini and colleagues assessed how breast cancer prognosis evolved over time for young women who opted for conservative treatment.
Researchers used the prospectively maintained breast cancer database from European Institute of Oncology in Milan to review data from 1,331 women aged younger than 40 years (median age at diagnosis, 35 years; range, 17-39) diagnosed with primary invasive early-stage breast cancer (T1-T3, N0-N1, M0). Median tumor size was 1.7 cm (range, 0.05-8).
All women underwent breast-conserving surgery and whole-breast radiotherapy at the institute between 1997 and 2010.
Investigators excluded women who underwent neoadjuvant chemotherapy; those with evidence of metastatic disease at presentation; and those with bilateral, inflammatory or recurrent breast cancer.
Follow-up continued until 2016. Endpoints included local recurrence, any breast cancer-related event and all-cause mortality.
Gentilini and colleagues stratified results based on tertiles defined by diagnosis date: 1997 to 2002 (n = 524), 2003 to 2005 (n = 350), or 2006 to 2010 (n = 457).
After median follow-up of 9.3 years, researchers reported 114 local recurrences, 289 breast cancer-related events and 138 deaths.
Risk for local recurrence declined significantly over time, from 1.42 per 100 person-years in the first diagnosis interval to 0.85 per 100 person-years in the second interval and 0.48 per 100 person-years in the third interval (P for trend = .028).
Gentilini and colleagues reported similar declines in risk — calculated as events per 100 person-years — for any breast cancer-related event (3.01 vs. 2.52 vs. 2.07; P = .004) and all-cause mortality (1.59 vs. 1.22 vs. 0.64; P = .003)
Results showed decreased risks with each passing year for local recurrence (HR = 0.93; 95% CI, 0.87-1), 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).
Gentilini and colleagues observed dramatic improvement in prognosis after 2005, when use of the anti-HER-2 monoclonal antibody trastuzumab (Herceptin, Genentech) and classification of breast cancer molecular subtypes became routine.
Incidence of ipsilateral recurrence declined by 7% per year during the study period. Incidence decreased from 1.42 per 100 person-years among those treated through 2002 to 0.48 per 100 person-years among those treated after 2005.
Researchers reported a 10-year local relapse rate of 4.8%, which they described as “much better” than previously reported among young women.
Gentilini and colleagues acknowledged their study was limited by its retrospective nature, including the potential that improved patient selection for breast-conserving therapy — due in part to increased referral for genetic counseling or testing — may have contributed to the improved outcomes.
However, use of data from a large number of patients included in a prospective, dedicated institutional database, along with long follow-up, provide a reliable perspective on how prognosis changed over time, researchers wrote.
The results may help reduce the number of unnecessary mastectomies among young women, they added.
“In everyday practice, physicians are often prone to recommend — and patients to prefer — mastectomy over breast-conserving surgery, owing to a belief that a more radical surgical approach would provide a better prognosis,” Gentilini and colleagues wrote. “It is valuable for young patients with breast cancer to realize that they can safety undergo a limited, nonmutilating surgical procedure and achieve a good oncological outcome.” – by Mark Leiser
Disclosures: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Breast cancer mortality has declined over the decades, and the study by Botteri and colleagues confirms this finding among patients aged younger than 40 years who underwent breast-conserving surgery at their institution.
Significant advances have been made in all facets of the multidisciplinary management of breast cancer. Our knowledge about potential genetic mutations predisposing to increased risk has flourished; more patients are aware of their risk, and genetic testing has become more easily accessible. Improvements in breast imaging have occurred, and they allow us to identify malignancies at their earliest stages when prognosis is optimal.
Surgical procedures have become more minimally invasive and cosmetically acceptable with oncoplastic procedures, novel reconstructive techniques and sentinel node biopsy. Although these advances have not affected survival, they certainly have had a positive effect in terms of cosmesis and quality of life.
Advances in radiation therapy have allowed treatment plans to be tailored to provide optimal locoregional risk reduction and, perhaps most significantly, there has been a plethora of novel agents that have been added to medical oncologists’ armamentarium, particularly with targeted therapies and, more recently, immunotherapy.
Although it is not possible in the study by Botteri and colleagues to discern the absolute impact of these advances on outcomes of patients with breast cancer, it is evident there has been a clear improvement in outcomes for these patients over time independent of stage at presentation, which also seems to be improving. These gratifying results are the result of the tireless work of clinicians, researchers and patients worldwide who have focused their efforts on the leading malignancy affecting women. Their work, however, is not yet done.
Click Here to Manage Email Alerts