A less radical approach but...

Lumpectomy works for women with breast cancer
under 35 only if followed with chemo

By Liliana Abruzzese

Each week in Canada around 407 women learn they have breast cancer, making it the most frequently diagnosed cancer among women. Of the thousands diagnosed each year, 102 will die every week.

Women under 35 years face more aggressive forms of breast cancer and have an increased risk of cancer recurrence than do middle-aged and older women diagnosed with the disease. Studies have shown that as a result many physicians are reluctant to suggest a conservative approach in younger women, often recommending modified radical mastectomy (RM) for early stage invasive breast cancer.

A new study, published in the online version of Cancer showed that the two types of surgical options for early breast cancer, breast conservation therapy (BCT) and RM, have similar survival rates. In BCT, also known as lumpectomy, the breast itself is conserved; surgery involves removing the malignancy and some normal tissue around it.

A team of Danish researchers conducted the large cohort study, which will appear in print in February, comparing survival outcomes of BCT and RM in young women. "Among middle-aged and older women with early breast carcinoma, BCT has been shown to have an effect on survival that is similar to that of modified RM," stated the study, led by Dr Niels Kroman and colleagues at the Danish Epidemiology Science Centre in Copenhagen. "Nonethe-less, it remains to be established whether BCT is also the optimal treatment option for early breast carcinoma in young women, because these women generally have a more aggressive disease and a higher frequency of local recurrence compared with older women."

Chemo's still a must
Using a Danish population-based database, survival rates were reviewed from a group of 9,285 premenopausal women younger than 50 years at diagnosis with primary breast cancer. The women, identified by the Danish Breast Cancer Cooperative Group, were diagnosed between 1982 (when BCT was introduced) and 1998. Of these women, 7,165 underwent RM and 2,120 received BCT. Some of these women had follow-up chemotherapy and some did not.

Researchers found no increased risk of death within 10 years after diagnosis among women less than 35 years who were treated with BCT compared with those who received RM, regardless of age at diagnosis. This was comparable to Fall other age groups (35-39 years, 40-44 years, 45-49 years) at diagnosis. However, the risk of local recurrence was five times greater in women under 35 who received BCT than those aged between 45 to 49 years.

The authors also reported a reduced survival rate for women under 35 who received BCT without adjuvant chemotherapy. These findings reinforce the importance of adhering to international guidelines for recommending adjuvant chemotherapy in addition to surgery in younger women.

According to this study, BCT appears to be as effective as a modified RM for early breast cancer treatment. The authors concluded that "[al]though the high frequency of local recurrence among younger patients represents a problem in itself, the current study did not find survival to be significantly different for young women who received BCT compared with those who underwent RM."