Lumpectomy, mastectomy confer similar survival outcomes for young women with breast cancer
Click Here to Manage Email Alerts
Younger women with nonmetastatic breast cancer who underwent breast-conserving surgery experienced similar OS as those who underwent mastectomy, according to study results.
The findings, presented during an American Society of Breast Surgeons Annual Meeting press briefing, indicate counseling patients regarding outcomes is key to reduce unnecessary morbidity from surgical procedures not indicated, given the increased use of mastectomy in this age group.
“In addition, our results emphasize the need for future attention on racial outcome disparities in young women,” Christine Pestana, MD, breast surgical oncology fellow at Atrium Health Levine Cancer Institute, said during a presentation.
Rationale and methods
Pestana said 1 in 68 women will develop breast cancer by age 40 years, and these women often present with advanced disease compared with their older counterparts.
“Outcome disparities persist between the two groups,” Pestana and colleagues wrote in the abstract. “Mastectomy rates are increasing in younger patients despite lack of data supporting improved survival.”
Researchers sought to examine the association between surgical approach and survival among 591 women aged younger than 40 years (median age, 37 years; 66% white, 25.9% Black) included in the Young Women’s Database at Levine Cancer Institute who underwent surgical intervention for nonmetastatic invasive breast cancer between 2010 and 2019. Nearly two-thirds of the women (64.5%) underwent mastectomy, whereas 35.5% underwent lumpectomy.
Researchers assessed patient age, race, BMI, disease stage, grade, molecular subtype, presence of lymphovascular space-invasion, extranodal extension, extent of surgery, presence and timing of chemotherapy, and presence of hormonal therapy.
They used univariable and multivariable Cox proportional hazard analyses to determine if patient, disease or treatment factors were associated with an increased risk for mortality.
Key findings
At a median follow-up of 67 months, 72 women (12%) died. More than half of women (53.3%) had hormone receptor-positive, HER2-negative disease, 20.8% had hormone receptor -positive/HER2-positive disease, 19.3% had triple-negative disease and 6.6% had HR-negative/HER2-positive disease.
Researchers observed no difference in OS between women who underwent mastectomy vs. breast-conserving surgery.
Most (85.4%) women with HR-positive/HER2-negative disease received antiestrogen therapy. Among them, researchers observed a 2.9-fold increased risk for death among women who had not been treated with hormone therapy vs. those who had (P = .02).
Results of univariate analysis showed Black patients had an increased risk for death across all molecular subtype categories. However, results of multivariate analysis showed the association only among Black women with triple negative breast cancer, who had a 5.7-fold higher mortality risk (P = .005), even after researchers accounted for all other risk factors.
“The results are particularly significant because 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 said in a press release.
Implications
Studies such as this this show lumpectomy, a far less aggressive approach with fewer possible complications and morbidity, is just as effective as removing an entire breast, according to Pestana.
She said the final decision on surgical approach should be based on shared decision-making.
“Our job is to provide education, encourage engagement and support our patients throughout their breast cancer journey with a focus on oncologic safety and quality of life,” she said during the presentation.
References:
Lumpectomy as effective as mastectomy for young breast cancer patients (press release). Available at: www.breastsurgeons.org/meeting/2022/releases/young_women. Published April 6, 2022. Accessed April 6, 2022.
Pestana C, et al. Young women with breast cancer: Does surgical approach impact overall survival? Presented at: American Society of Breast Surgeons Annual Meeting (hybrid meeting); April 6-10, 2022; Las Vegas.
Collapse
Pestana C, et al. Young women with breast cancer: Does surgical approach impact overall survival? Presented at: American Society of Breast Surgeons Annual Meeting (hybrid meeting); April 6-10, 2022; Las Vegas.
Click Here to Manage Email Alerts