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Breast-Conserving Therapy Gets Boost for Younger Women

Younger women with early breast cancer who have breast-conserving surgery do just as well as those who undergo mastectomy, two new studies suggest.

Sept. 7, 2011 -- Younger women with early breast cancer who have breast-conserving surgery do just as well as those who undergo mastectomy, two new studies suggest.

Young age at diagnosis is considered a risk factor for breast cancer recurrence. Also, studies done years ago suggested that younger women who have breast-conserving treatment (lumpectomy followed by radiation) may face a higher chance of having their cancer come back than older women, says researcher Julliette Buckley, MD, a fellow in breast surgery at Massachusetts General Hospital in Boston.

"With these new studies, we can reassure younger patients who are considering less aggressive treatment with breast-conserving treatment that their survival and recurrence rate [will be similar to] that of younger women having mastectomy," she tells WebMD.

The findings were presented at a news briefing held in advance of the Breast Cancer Symposium 2011 in San Francisco.

Survival Rates Similar After Mastectomy, Breast-Conserving Therapy

For one study, Usama Mahmood, MD, and colleagues used a National Cancer Institute database to look at survival rates among nearly 5,000 women aged 20 to 39 who were diagnosed with early-stage breast cancer between 1990 and 2007. About half the women received breast conservation therapy, and the other half underwent mastectomy.

Fourteen percent of those who had breast-conserving surgery and those who had mastectomy were alive and free of breast cancer after 10 years, says Mahmood, MD, a fellow in radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

About 16% of women in both groups died due to any cause over the 10-year period.

The groups were similar in terms of characteristics such as tumor size that affect survival rates.

For the other study, Buckley and colleagues reviewed the medical records of 628 women aged 40 and younger who were diagnosed with breast cancer between 1996 and 2008.

The chance of cancer coming back in the same breast or spreading to the lymph nodes under the arm was 13% over a 10-year period in the group that got breast-conservation treatment and 11% in the mastectomy group, a difference so small it could have been due to chance.

In the study, 30 of 421 women who underwent breast-conserving therapy and 12 of 161 patients who had a mastectomy had cancer come back in the same breast or in lymph nodes under the arm.

The analysis took into account other risk factors for recurrence, including aggressiveness of the tumor and type of surgery.

Better Imaging Credited

Buckley credits the improved recurrence and survival rates to enhanced imaging scans that allow doctors to better select patients for lumpectomy based on such factors as tumor size. Also, advances in chemotherapy and radiation treatment have reduced risks, she says.

Although breast-conserving therapy is generally thought of as "less invasive" than mastectomy, it too carries risks, Buckley tells WebMD.

"If you have lumpectomy, you have to have radiation, and that's typically six weeks of treatment, nearly every day. Patients feel very tired. There can be skin changes and other problems.

"Some women prefer to have a mastectomy and be done, though that often means breast reconstruction surgery," Buckley says.

She says she doesn't know of any studies comparing the long-term costs of the two procedures in younger women.

"Age is no longer a reason to reject breast-conserving treatment," says American Society of Clinical Oncology spokesman Andrew Seidman, MD, a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City.

That said, there are certain younger women who might benefit more from mastectomy, he tells WebMD. They include women with pockets of tumor cells in more than one area of the breast and those who have BRCA gene mutations, which increase women’s risk for breast cancer, Seidman says.

In 2011, there will be an estimated 290,000 new cases of breast cancer in the U.S.

Mahmood conducted much of his research while at the University of Maryland Marlene and Stewart Greenebaum Cancer Center.

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