Young Patients Face Greater Risk of Local Recurrence With Breast Conservation

A study presented at the European Society for Radiotherapy and Oncology (ESTRO) 35, ongoing in Turin, Italy, has shown that women younger than 45 years, diagnosed with early stage breast cancer, who chose breast conservation therapy (BCT) followed by radiation, over mastectomy, had a significantly greater risk of local disease recurrence. Local recurrence also increased the risk of metastasis and death in young women with BCT.

The study, conducted by researchers in Aarhus University Hospital, Denmark, followed 1076 Danish women, diagnosed with breast cancer between 1989 and 1998, for 20 years. With tumors less than 5 cm in diameter, the diagnosis was of a low-risk disease. A majority of those diagnosed (712) chose mastectomy over BCT (364). Also, chemotherapy was not administered because of the low risk diagnosis.

A significant difference in the percentage of women with local recurrence was observed at 20 years post diagnosis. The authors report that 18% (66) of women who chose BCT had a local recurrence of breast cancer, compared with only 6.7% (55) of those who chose mastectomy. Further, older women has a much faster recurrence: within the first 5 years following mastectomy. Younger women, on the other hand, faced recurrence over a 10-year period.

“We found that among patients older than 45 years, receiving BCT, local recurrence was not associated with distant metastasis and the 20-year mortality was not different between BCT and mastectomy,” said study author Tinne Laurberg, MD, in a statement. She continued that this confirmed previous findings that it is safe to offer BCT and adjuvant radiation therapy to older, lymph-node negative patients.

“In contrast, among the patients younger than 45 years, local recurrence was associated with distant metastasis, and young patients treated with BCT had an increased risk of death during the 20 years, either from their disease or from other causes, compared to those who underwent mastectomy,” Laurberg said. Laurberg believes that their findings will help define treatment plans for younger women diagnosed with lymph-node negative disease.

Older women, the study found, did not show an association between local recurrence and the risk of metastasis. Additionally, there was no difference in the number of women who died following BCT versus mastectomy.

ESTRO’s president, Philip Poortmans, MD, PhD, had a recommendations to offer clinicians. He suggested reassessing the risk of local recurrence with using less aggressive treatment for breast cancer, especially when treating the primary tumor.

Reference

Is breast conserving therapy or mastectomy better for early breast cancer? Science Daily website. https://www.sciencedaily.com/releases/2016/04/160430100556.htm. Published April 30, 2016. Accessed May 2, 2016.