Early-stage breast cancer diagnosed in women age 40 and younger has a somewhat worse overall prognosis than early-stage breast cancer diagnosed in older women. Still, lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for younger women with an average risk of the cancer coming back (recurrence).
Recent research has shown that more and more young women diagnosed with early-stage breast cancer are choosing to have mastectomy instead of lumpectomy, possibly because they believe that the more aggressive surgery option might improve their overall prognosis.
Results from a very large study presented at the Multidisciplinary Breast Cancer Symposium in September 2011 reported that young women who had lumpectomy followed by radiation therapy were no more likely to have the breast cancer come back and just as likely to survive breast cancer as young women who had mastectomy.
Researchers looked at the records of 14,760 young women diagnosed with early-stage breast cancer between 1990 and 2007. All the women were under the age of 40 when diagnosed. Their anonymous medical records were in a U.S. database called the Surveillance, Epidemiology, and End Results (SEER) database.
About 45% of the women had lumpectomy followed by radiation therapy and 55% had mastectomy. On average, there was more than 5.5 years of follow-up information in the records. The researchers compared recurrence rates and projected 10-year survival of the women who had lumpectomy to the women who had mastectomy.
Overall, there were no differences in recurrence rates or survival between the two groups of women:
- Cancer recurred near the breast where cancer was originally diagnosed (called loco-regional recurrence) in 7.34% of women who had lumpectomy and 7.40% of women who had mastectomy.
- Projected 10-year survival was 83.5% for women who had lumpectomy and 83.6% for women who had mastectomy.
The results of this study agree with findings from other studies suggesting that lumpectomy followed by radiation is as good as mastectomy for many young women diagnosed with early-stage breast cancer. The results should be reassuring for young women who would prefer having lumpectomy rather than mastectomy. Still, there are medical and personal reasons that may make mastectomy a better choice for some women:
- the cancer is large, has spread to lymph nodes, or is in multiple locations in the breast
- lumpectomy was unsuccessful
- a woman has higher-than-average risk for recurrence or another, new breast cancer (these women may choose to have both breasts removed to greatly reduce risk)
- reducing the risk of recurrence or another, new breast cancer diagnosis, even in women without higher-than-average risk
- avoiding radiation therapy
- better cosmetic and reconstructive options
Although there has been a trend for young women to choose mastectomy over lumpectomy in recent years -- possibly because doctors and patients consider it a more aggressive, and therefore better, option for most women -- a 2009 study found that doctors are doing a good job of recommending the breast cancer surgery that makes sense based on a woman's specific situation. The study showed that most recommendations for mastectomy over lumpectomy were for specific, appropriate reasons, and that only 6.2% of the mastectomy recommendations were questionable.
If you've been diagnosed with early-stage breast cancer, you and your doctor will discuss a surgical approach that makes the most sense for you and your unique situation. It's a good idea to ask your doctor about the cancer characteristics that are influencing the surgery recommendation. Your surgery decision also should reflect your personal beliefs and preferences. Accurate information about the cancer, as well as a clear understanding of what you want, are essential to developing a treatment plan that makes the most sense for you.