Young women with early breast cancer have similar survival with breast conservation, mastectomy

Steven J. Feigenberg, M.D., a radiation oncologist at the University of Maryland Marlene and Stewart Greenebaum Cancer Center and an associate professor of radiation oncology at the University of Maryland School of Medicine, says that mastectomies among young women have been on the rise, in part because of concerns regarding recurrence of their cancer.

"We believe these findings are very significant for young women with early-stage breast cancer who might choose to have a mastectomy in the hope of improving their outcome. This study confirms that breast-conservation therapy is a safe, effective treatment option and will not have a detrimental effect on survival," Dr. Feigenberg, the study's senior author, says.

He says this is the largest study to date to compare survival in young women with early-stage breast cancer who had breast-conservation therapy vs. mastectomy. Women under 40 can have more aggressive tumors and are often at higher risk for having their cancer recur. Previous studies have suggested that young women have higher local recurrences of their cancer with breast-conservation therapy, but these studies did not demonstrate an effect on survival, Dr. Feigenberg says.

Usama Mahmood, M.D., the lead author, says, "We looked at data from nearly 15,000 women in our retrospective analysis and saw no difference in survival between those who had breast-conservation therapy and those who had a mastectomy." Dr. Mahmood, a resident in the Department of Radiation Oncology at the University of Maryland who is now at the University of Texas M.D. Anderson Cancer Center, will present the data at the Breast Cancer Symposium.

E. Albert Reece, M.D., Ph.D., M.B.A., vice president of medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, says, "This large analysis breaks new ground in advancing what we know about how to treat young women with early-stage breast cancer. It will most certainly help young women and their doctors to better understand the most appropriate treatment options and make decisions based on what's best for each patient."

Researchers analyzed data from the SEER (Surveillance, Epidemiology and End Results) registry, which is maintained by the National Cancer Institute. They identified 14,764 women, age 20 to 39, who were diagnosed with early-stage breast cancer between 1990 and 2007. Forty-five percent of the women had breast-conservation surgery, and 55 percent had a mastectomy. Patients who received breast-conservation therapy were older and had smaller, lower-grade tumors and less lymph-node involvement. The median follow-up was nearly six years, although some patients were followed for 10 years, 15 years and beyond. All of the breast cancers were early-stage. Sixty-four percent of the patients were white.

To confirm the results of the study, the researchers did a "matched pair analysis, using a smaller group of 4,644 patients who had undergone breast-conservation therapy and mastectomy. Patients were matched for such factors as year of their diagnosis, age, grade, tumor size, number of positive lymph nodes, the number of nodes removed and their particular type of breast cancer, and still there was no difference in overall survival or survival specific to breast cancer. Similarly, a separate analysis was performed on the youngest group of patients, under age 33, again seeing no difference in outcomes.

The overall survival for those who had breast conservation therapy was 92.5 percent after five years, 83.5 percent after 10 years, and 77 percent after 15 years. That compares with 91.9 percent, 83.6 percent and 79.1 percent, respectively, for those who had mastectomies. In addition, the breast cancer-specific survival rates were similar between the two groups.

The study's authors include members of the multidisciplinary breast cancer team at the University of Maryland Greenebaum Cancer Center. In addition to Dr. Feigenberg, co-authors include Katherine Tkaczuk, M.D., a medical oncologist who heads the Breast Evaluation and Treatment Program; Susan Kesmodel, M.D., a surgical oncologist; and two medical oncologists, Saranya Chumsri, M.D., and Ting Bao, M.D.