Early-Stage Young Breast Cancer Patients: Impact of Local Treatment on Survival

• DOI: 10.1016/j.ijrobp.2011.02.060
• Publication Date: 2011-05-24T01:47:04Z
• Authors: Enja J. Bantema-J...; Linda de Munck; Otto Visser; Pax H.B. Willemse; Johannes A. Lange...; Sabine Siesling; John H. Maduro
• Keywords: Adult; Cancer Research; Breast-conserving therapy; Breast Neoplasms; METIS-280055; Mastectomy, Segmental; Young Adult; 03 medical and health sciences; ADJUVANT CHEMOTHERAPY; AGE; Breast cancer; 0302 clinical medicine; SDG 3 - Good Health and Well-being; EUROPEAN ORGANIZATION; CONSERVING THERAPY; Humans; Registries; RECURRENCE; Population-based cancer registry; Mastectomy; Netherlands; Retrospective Studies; Radiation; Lymphatic Irradiation; Young age; Age Factors; WOMEN; RANDOMIZED-TRIALS; Survival Analysis; Tumor Burden; 3. Good health; Oncology; Radiology Nuclear Medicine and imaging; Lymphatic Metastasis; Axilla; RADICAL-MASTECTOMY; RISK-FACTORS; Lymph Node Excision; Female; Radiotherapy, Adjuvant; POOR SURVIVAL; Follow-Up Studies

In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that BCT impairs survival. The aim of our study was to compare the effect of BCT with mastectomy on overall survival (OS) in young women with early-stage breast cancer.From two Dutch regional population-based cancer registries (covering 6.2 million inhabitants) 1,453 women <40 years with pathologically T1N0-1M0 breast cancer were selected. Cox regression survival analysis was used to study the effect of local treatment (BCT vs. mastectomy) stratified for nodal stage on survival and corrected for tumor size, age, period of diagnosis, and use of adjuvant systemic therapy.With a median follow-up of 9.6 years, 10-year OS was 83% after BCT and 78% after mastectomy, respectively (unadjusted hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.09-1.72). In N0-patients, 10-year OS was 84% after BCT and 81% after mastectomy and local treatment was not associated with differences in OS (HR 1.19; 95% CI, 0.89-1.58; p = 0.25). Within the N1-patient group, OS was better after BCT compared with mastectomy, 79% vs. 71% at 10 years (HR 1.91; 95% CI, 1.28-2.84; p = 0.001) and in patients treated with adjuvant hormonal therapy (HR 0.34; 95% CI, 0.18-0.66; p = 0.001).In this large population-based cohort of early-stage young breast cancer patients, 10-year OS was not impaired after BCT compared with mastectomy. Patients with 1 to 3 positive lymph nodes had better prognosis after BCT than after mastectomy.