Contemporary Locoregional Recurrence Rates in Young Patients With Early-Stage Breast Cancer

Abstract

Purpose The aim of this study was to evaluate contemporary rates of local recurrence (LR) and regional recurrence (RR) in young patients with breast cancer in relation to tumor biology as expressed by biomarker subtypes. Patients and Methods Women < 35 years of age who underwent surgery for primary unilateral invasive breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. Patients were categorized according to biomarker subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year risks of developing LR and regional lymph node recurrence were estimated by using Kaplan-Meier statistics. Results A total of 1,000 patients were identified, of whom 59% had a known subtype: 39% HR-positive/HER2-negative; 17% HR-positive/HER2-positive; 10% HR-negative/HER2-positive; and 34% HR-negative/HER2-negative (triple negative). Overall 5-year LR and RR rates were 3.5% and 3.7%, respectively. A decreasing trend for both rates was observed over time and was accompanied by a significant decrease in the risk of distant metastases (DM). LR occurred in 4.2%, RR in 6.1%, and DM in 17.8% of patients in 2003, and in 3.2%, 4.4%, and 10.0%, respectively, in 2008. LR and RR rates varied with biomarker subtype. These differences were borderline significant when analyzed for the entire study period (P = .056 and P = .014, respectively) and leveled off after the introduction of trastuzumab after 2005 (P = .24 and P = .42, respectively). Patients with lymph node metastases at the time of diagnosis had an increased risk of RR. The type of surgery performed—breast-conserving or mastectomy—did not influence rates of LR and RR. Conclusion Overall, the rates of LR and RR in young patients with early-stage breast cancer were relatively low and varied by biomarker subtype.

Analysis of breast cancer in young women in the Department of Defense (DOD) database

“…These data compare closely to the Prospective study of Outcomes in Sporadic and Hereditary breast cancer (POSH), where data was collected from 2000 to 2008: 73% of patients < 40 yo received adjuvant chemotherapy, predominately anthracycline based [15]. Also, in a Netherlands cohort, collected between 2003 and 2008, 93% of patients < 35 yo had chemotherapy [29]. The data confirm a practice of widespread use of chemotherapy in young breast cancer patients.…”

“…In the DoD cohort, patients < 40 yo underwent proportionally more mastectomies (69%), with fewer breast conserving surgeries (31%). The mastectomy rate is higher than that reported for patients < 35 yo from the Netherlands, where 45% had breast conserving therapy and 55% mastectomy [29]. Breast conserving therapy was recently reported to result in low numbers of local relapses in young breast cancer patients [30].…”

General Overview and Treatment Recommendations for Young Women with Breast Cancer

“…Other series also confirmed that young age is associated with increased risk for local recurrence after BCS [58][59][60] . Nevertheless, a recent population-based study from The Netherlands showed that five-year rates of developing local or regional recurrence in women < 35 years of age were only 3.5 and 3.7%, respectively 61 . These were not influenced by surgery type (BCS vs. mastectomy) and were substantially lower than reported in the past 60,62 .…”

“…These were not influenced by surgery type (BCS vs. mastectomy) and were substantially lower than reported in the past 60,62 . A trend for decreasing risk of locoregional breast cancer recurrence has been observed among all breast cancer patients and likely represents screening-associated stage migration, with an increasing proportion of patients diagnosed with smaller tumors as well as improvements in adjuvant therapies 61 .…”

“…Given the similar overall survival, the low risk of locoregional recurrence in contemporary studies, and improved cosmetic results, BCS with or without oncoplastic repair is the surgical treatment of choice whenever technically feasible, even in young breast cancer patients 53,61,63 .…”