Comparison of Recurrence and Survival Rates after Breast-Conserving Therapy and Mastectomy in Young Women with Breast Cancer

Abstract

Multiple randomized trials have demonstrated that breast-conserving therapy with partial mastectomy and radiotherapy provides survival equivalent to that seen with mastectomy for patients with early-stage breast cancer. Breast-conserving therapy has been associated with better quality of life relative to mastectomy and has become the standard of care for patients with early-stage breast cancer. Young age has been identified as a risk factor for recurrence and death from breast cancer. Some studies have suggested that young women (less than 35 or 40 years of age) have inferior outcomes with breast-conserving therapy, implying that such women may be better served by mastectomy. On review of the available literature, there is no definitive evidence that mastectomy provides a consistent, unequivocal recurrence-free or overall survival benefit over breast-conserving therapy. However, available meta-analyses have not compared outcomes in young women specifically, and such analyses should be performed. In the interim, breast-conserving therapy is not contraindicated in young women (less than 40 years of age) and can be used cautiously; however, such women should be advised of the lack of unequivocal data proving that survival is equivalent to that with mastectomy in their age group.

Impact of age, intrinsic subtype and local treatment on long-term local-regional recurrence and breast cancer mortality among low-risk breast cancer patients

“…Six randomized controlled trials comparing mastectomy and BCT all included a low proportion of young breast cancer patients (12-23%) [44], making it hard to draw any conclusion for this subgroup. Few cohort studies restricted to young breast cancer patients have been published [2,[45][46][47][48][49], and they are limited by the inclusion of a mixture of different TNM stages, by the variety of adjuvant systemic treatments offered, and by a median follow-up time of less than 10 years.…”

Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

“…Thus, the rates of breast cancer recurrence after BCT are nowadays similar to the rates of local recurrence seen after mastectomy. However, it has to be stated that the rates are obviously not identical; especially in younger patients, the discrepancy becomes evident [28,29]. On the one hand, based on a review of the available literature there is no definitive evidence that mastectomy provides a consistent recurrence-free survival or OS benefit over BCT.…”

Magnetic Resonance Imaging after Breast Oncoplastic Surgery: An Update

“…BCS followed by radiation treatment represents the standard of care in patients with early-stage breast cancer [8]. Several studies confirmed that this procedure shows equivalent survival rates (more than 20 years) compared to mastectomy [8][9][10]. Breast oncoplastic surgery (BOS) comprises the surgical excision of breast cancer that allows oncologically safe breast conservation and breast remodeling, reducing postoperative deformities [11][12][13].…”