Although most experts advise that rates of recurrence and overall survival are similar after lumpectomy with radiation (breast conserving therapy or BCT) or mastectomy, many more women with early-stage disease are choosing mastectomy instead.
But should your age influence your treatment choice?
A new Danish study has found that after BCT, women age 45 or younger had higher local recurrence (the return of breast cancer in the same breast or in nearby lymph nodes) than women in the same age group who had mastectomy without radiation.
What’s unique about this study is that it looked at women younger than 45.
Making the age distinction is important, because although cancer mostly occurs in women who are 60 and older in the United States, younger women tend to have more aggressive tumors and higher rates of recurrence.
This research concluded that, for women with early-stage disease and no evidence of cancer in their lymph nodes:
- Under age 45: Mastectomy provided better rates of recurrence, distant metastasis and survival
- Over age 45: Lumpectomy and radiation was similar to mastectomy
- 25% rate of recurrence after BCT compared to 11% in older women.
- 13% rate of recurrence after mastectomy compared to 3% in older women
- 60 to 70% higher risk of mortality after BCT
- Double the risk of distant metastasis to bones and organs associated with local recurrence after BCT
One drawback is that the research is based on women who were treated from 1989 to 1998; breast cancer treatments, including radiation therapy, have vastly improved since then.
In an interview with MedPage Today, Dr. Amy Degnim, who practices at the Mayo Clinic and wasn’t involved in the study, said: "Nevertheless, these long-term data are very important, especially for young women who will live a long time after their cancer diagnosis and in whom the long-term risk of cancer recurrence is likely a major factor in their choice of surgical treatment."
Laurberg T, et al. "Long-term age dependent failure pattern after BCT vs mastectomy in low-risk breast cancer patients." European Society for Therapeutic Radiology and Oncology Conference (2016); Abstract E35-1485.