Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery

Orozco, Javier I. J.; Keller, Jennifer; Chang, Shu Ching; Fancher, Crystal E.; Grumley, Janie

doi:10.1245/s10434-022-12190-z

Cited by 13 publications

(4 citation statements)

References 41 publications

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“…Five studies evaluated data from the National Cancer Database (NCDB). One study showed that BCS was associated with an improved OS, compared to a unilateral or bilateral mastectomy, whereas two studies, one evaluating invasive disease and another ductal carcinoma in situ (DCIS) found no difference in OS, based on the surgical procedure [ 29 , 30 , 31 ]. The rates of BCS decreased over the study period in three studies, for both patients with DCIS and invasive disease [ 29 , 32 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

2022

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Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, which evaluated breast surgery type, axillary surgery, contralateral prophylactic mastectomy (CPM), surgical timing, psychological factors, disparities, and imaging use. AYA patients had equivalent oncologic outcomes with breast conserving surgery (BCS) or mastectomy. CPM did not improve survival. There are limited data on axillary management in the AYA population, and while more data would be beneficial, this is currently extrapolated from the general breast cancer population. A shorter time to initiate treatment correlated to better outcomes, and disparities need to be overcome for optimal outcomes. AYA patients appreciated involvement in clinical decisions, and shared decision making should be considered whenever possible. Providers must keep these factors in mind when counseling AYA patients, regarding the surgical management of breast cancer.

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Section: Resultsmentioning

confidence: 99%

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

2022

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“…However, most data find no differences in distant recurrence or OS by type of surgery among younger patients. A recent study evaluating OS in women under the age of 40 who underwent BCS versus mastectomy did not find any association between locoregional therapy and OS when adjusting for clinicopathologic factors 24 . Interestingly, analyses of large data sets have instead found an association between undergoing BCS and improved OS compared with mastectomy 25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…A recent study evaluating OS in women under the age of 40 who underwent BCS versus mastectomy did not find any association between locoregional therapy and OS when adjusting for clinicopathologic factors. 24 Interestingly, analyses of large data sets have instead found an association between undergoing BCS and improved OS compared with mastectomy. 25,26 In our study, we found no relationship between the type of breast surgery and LRFS, even among the younger patients in the cohort.…”

Section: Discussionmentioning

confidence: 99%

Breast Conservation Surgery and Mastectomy have Similar Locoregional Recurrence Following Neoadjuvant Chemotherapy

et al. 2023

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Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer. Cox proportional hazards models were used to evaluate associations between surgical procedure (BCS vs mastectomy) and LRFS adjusted for age, tumor receptor subtype, clinical T category, clinical nodal status, and residual cancer burden (RCB). In 1462 patients, surgical procedure was not associated with LRR or LRFS on either univariate or multivariate analysis. The unadjusted incidence of LRR was 5.4% after BCS and 7.0% after mastectomy, at a median follow-up time of 3.5 years. The strongest predictor of LRR was RCB class, with each increasing RCB class having a significantly higher hazard ratio for LRR compared with RCB 0 on multivariate analysis. Triple-negative receptor subtype was also associated with an increased risk of LRR (hazard ratio: 2.91, 95% CI: 1.8–4.6, P < 0.0001), regardless of the type of operation. In this large multi-institutional prospective trial of patients completing NAC, we found no increased risk of LRR or differences in LRFS after BCS compared with mastectomy. Tumor receptor subtype and extent of residual disease after NAC were significantly associated with recurrence. These data demonstrate that BCS can be an excellent surgical option after NAC for appropriately selected patients.

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“…Similar to a recent survey among 383 Lebanese women with a median age of 32 years, ‘concern about residual cancer and/or cancer recurrence’, ‘cost of surgery and follow-up and the absence of health coverage’, and ‘side effects of radiotherapy’ were one of the main reasons for choosing mastectomy over BCS [ 24 ]. In a survival analysis of 15,611 breast cancer patients aged ≤40 years old utilizing the National Cancer Database (2006–2016), the BCS rate was 60.9% with an equivalent 5-year OS to mastectomy with or without RT [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Young Filipino breast cancer patients have worse survival outcomes

Yap,

Marquez,

De La Serna

2023

ecancer Journal

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Background In the 2020 GLOBOCAN report, breast cancer is the 3rd most common cause of cancer-related mortality in the Philippines. The incidence of breast cancer in the young (≤40 years) was reported to be higher in the Philippines compared to other Asian countries. Several studies have consistently demonstrated poor survival outcomes in this age group due to its aggressiveness and unique tumour biology. However, data on survival outcomes of young Filipino breast cancer patients remains unknown in the Philippines. Methods A retrospective study was performed involving patients with stage I–III breast cancer who underwent definitive surgery from January 2010 to December 2015 at a single-tertiary institution. Patients were grouped according to age (≤40 and >40 years old). Their clinicopathological characteristics, treatment profile and 5-year survival outcomes were analyzed. Results A total of 524 Filipino patients (15.1% aged ≤40 years) were included. Younger patients were diagnosed at a higher stage and pathologic grade. A negative hormone receptor, high Ki67 status, and triple negative breast cancer (TNBC) subtypes were also more common among younger patients. The overall breast-conserving surgery rate was low at 8.9%. The use of adjuvant chemoradiotherapy was more common and both 5-year overall survival (OS) and disease-free survival (DFS) were lower (61.1% versus 77.1% and 31.1% versus 66.8%, respectively) in the ≤40-year-old group. In the multivariate analysis, age group, tumour size, and nodal status were significant predictors for DFS. However, only tumour size was significant for OS. Conclusion Young Filipino breast cancer patients have demonstrated unique pathologic characteristics with associated lower survival outcomes similar to the published literature. Increasing awareness of cancer screening practices among young women, provision of equitable access to healthcare, and prompt management of breast cancer in the young are crucial.

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Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery

Cited by 13 publications

References 41 publications

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

Breast Conservation Surgery and Mastectomy have Similar Locoregional Recurrence Following Neoadjuvant Chemotherapy

Young Filipino breast cancer patients have worse survival outcomes

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