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Is Mastectomy Superior to Breast-Conserving Treatment for Young Women?

2007; Elsevier BV; Volume: 67; Issue: 5 Linguagem: Inglês

10.1016/j.ijrobp.2006.11.032

1879-355X

Geneviève Coulombe, Scott Tyldesley, Caroline Speers, Chuck Paltiel, Christina Aquino‐Parsons, Vanessa Bernstein, Pauline T. Truong, Mira Keyes, Ivo A. Olivotto,

Breast Lesions and Carcinomas

Purpose: To examine whether modified radical mastectomy (MRM) improves outcomes compared with breast-conserving treatment (BCT) in young women. Methods and Materials: Women aged 20–49 years, diagnosed with early breast cancer between 1989 and 1998, were identified. Management with BCT or MRM was compared for local (L), locoregional (LR), and distant relapse-free survival (DRFS) and breast cancer–specific survival (BCSS) by age group (20–39 years, 40–49 years). The analysis was repeated for patients considered "ideal" candidates for BCT: tumor size ≤2 cm, pathologically negative axillary nodes, negative margins, and no reported ductal carcinoma in situ. Results: A total of 1,597 women received BCT, and 801 had MRM. After a median follow-up of 9.0 years, the outcomes (L, LR, BCSS) were worse for the younger age group; however, the outcomes were not statistically different by type of local treatment. For women aged 20–39 years considered "ideal" for BCT, those treated with BCT had slightly lower LRFS compared with those treated with MRM (p = 0.3), but DRFS and BCSS were similar. Conclusions: A difference in LRFS at 10 years potentially favored MRM among women aged 20–39 years considered "ideal" BCT candidates but was not statistically significant and did not translate into a noticeable difference in DRFS or BCSS. Our data suggest that young age alone is not a contraindication to BCT. Purpose: To examine whether modified radical mastectomy (MRM) improves outcomes compared with breast-conserving treatment (BCT) in young women. Methods and Materials: Women aged 20–49 years, diagnosed with early breast cancer between 1989 and 1998, were identified. Management with BCT or MRM was compared for local (L), locoregional (LR), and distant relapse-free survival (DRFS) and breast cancer–specific survival (BCSS) by age group (20–39 years, 40–49 years). The analysis was repeated for patients considered "ideal" candidates for BCT: tumor size ≤2 cm, pathologically negative axillary nodes, negative margins, and no reported ductal carcinoma in situ. Results: A total of 1,597 women received BCT, and 801 had MRM. After a median follow-up of 9.0 years, the outcomes (L, LR, BCSS) were worse for the younger age group; however, the outcomes were not statistically different by type of local treatment. For women aged 20–39 years considered "ideal" for BCT, those treated with BCT had slightly lower LRFS compared with those treated with MRM (p = 0.3), but DRFS and BCSS were similar. Conclusions: A difference in LRFS at 10 years potentially favored MRM among women aged 20–39 years considered "ideal" BCT candidates but was not statistically significant and did not translate into a noticeable difference in DRFS or BCSS. Our data suggest that young age alone is not a contraindication to BCT. Is Mastectomy Superior to Breast-Conserving Treatment for Young Women?: In Regard to Coulombe et al. (Int J Radiat Oncol Biol Phys 2007;67:1282–1290)International Journal of Radiation Oncology, Biology, PhysicsVol. 69Issue 2PreviewTo the Editor: We read the article of Coulombe et al.(1) with great interest. A total of 2,398 patients (1,597 treated with breast-conserving surgery plus radiotherapy, and 801 treated with mastectomy) were evaluated in this retrospective study. As mentioned by the authors, one of the shortcomings of this study was that the groups were not balanced in many aspects. Nevertheless, they found that younger patients had a worse prognosis regarding all outcome measures. Full-Text PDF