Lumpectomy as Good as Mastectomy for Very Young Women With Breast Cancer

A study published in the Journal of Surgical Oncology found that getting less extensive surgery, when recommended, doesn’t mean a higher chance of death or of cancer travelling to distant organs for very young women with breast cancer. This research expanded on past studies that had the same results, but in women of all ages.

Background and Goals

When lumpectomy is the surgery considered medically necessary, many women, especially younger ones, choose mastectomy instead. Some feel removing the whole breast, rather than only the tumor and some tissue around it, lowers their risk of recurrence and of dying from breast cancer even if their doctors say the less extensive surgery is enough. Usually, mastectomy is offered for women with larger tumors and more cancer in their lymph nodes, and lumpectomy plus radiation is offered for women with smaller tumors and less cancer in their lymph nodes.

Research already shows that both types of surgery have the same effect on risk of recurrence or death, when used as recommended by surgical oncologists. But that research looked mostly at older women. Since younger women diagnosed with breast cancer already have a higher risk of recurrence and death than older women, it’s important to do research that focuses on younger women. The researchers on this study wanted to learn if type of breast surgery affected young women’s risk of recurrence or death differently than older women.

Design

These researchers pulled medical records from the Ontario Cancer Registry, which has recorded all cancer diagnoses in the Canadian province of Ontario since 1964. They found all cases of early-stage breast cancer diagnosed in women age 35 or younger between 1994 and 2003. Women who didn’t have surgery after diagnosis or who developed metastatic breast cancer within 6 months of diagnosis were excluded from this study.

In total, they found 1,381 very young women who matched the study’s needs. They then looked at a median of 11 years of data collected after breast cancer diagnosis from each woman’s medical records, and noted whether the women had local or distant recurrences, and how many of the women died. They kept track of whether each woman had mastectomy or lumpectomy.

Results

Of the 1,381 women, 57 percent had a lumpectomy and 43 percent had a mastectomy.

• Most of the lumpectomy group had radiation afterward, which is standard treatment for most women who have this kind of surgery
• About half of the women who had a mastectomy had radiation afterward
• Use of chemotherapy was similar in both groups

Recurrences

A recurrence of any kind of was seen in 41 percent of all women in the study. Distant recurrence was the most common type of recurrence. It happened in

• 13 percent of the lumpectomy group
• 25.3 percent of the mastectomy group

Though distant recurrence was less common in the lumpectomy group, cancer returning in the breast was more common in those who had lumpectomy than those who had mastectomy. It happened in

• 12.4 percent of the lumpectomy group
• 7.5 percent of the mastectomy group

Survival

After 5 years,

• 87 percent of the lumpectomy group were alive
• 73 percent of the mastectomy group were alive

Of all the study participants, 31.1 percent died within the median 11 years of follow-up.

Recurrence-Free Survival

After 5 years

• 77 percent of the lumpectomy group were alive and recurrence-free
• 57 percent of the mastectomy group were alive and recurrence-free

After 10 years

• 68 percent of the lumpectomy group were alive and recurrence-free
• 50 percent of the mastectomy group were alive and recurrence-free

The statistics in this study appear to show not only that lumpectomy is not worse than mastectomy, and that it is actually better. But women who need a mastectomy tend to have larger tumors and more cancer in their lymph nodes, and that was true of the women in this study who had mastectomies. Because of this, as a group they are expected to see more recurrences and death from breast cancer, because the cancer is more aggressive. That could make it look like mastectomy works less well, when really it was just used more often for difficult cases.

For this reason, this study can’t prove lumpectomy is better than mastectomy in all people and situations. But it does show that in this group of very young women, those who had lumpectomy were not more likely to face distant recurrence or death than those who had a mastectomy.

Limitations

This was a retrospective study, which means the researchers looked at things that happened in the past and drew conclusions from what they saw in the data. These types of studies are not as reliable as randomized trials, which recruit people who need treatment during the study’s timeframe, divide them into groups and randomly assign them to certain treatments, to learn which treatment works best. That’s because randomly assigning similar groups of people to different treatments prevents other factors, like changes in guidelines or new research findings, from impacting the results.

What This Means for You

Women under 35 make up about 2 percent of all breast cancer cases in the U.S. and few studies focus on their unique problems and needs. You might worry your treatment plan is based on studies that haven’t focused on people like you. This study is important because it suggests that something we know is true in general for people with breast cancer – that lumpectomy prevents distant recurrence and death as well as mastectomy does – is also true in very young women.

Recurrence in the breast was more likely in those who had a lumpectomy instead of a mastectomy, but “the message from this paper for me was that what we do on the chest wall – breast-conserving surgery or mastectomy – doesn’t seem to change how often we see these patients recur elsewhere,” says the study’s lead researcher, May Lynn Quan, MD, MSc, FRCSC. Dr. Quan is an associate professor of surgery, oncology and community health sciences at the University of Calgary, in Alberta, Canada, and medical director of the Calgary Breast Health Program at Foothills Medical Centre.

Mastectomy is the right surgery for many women. It can help prevent recurrence and provide women with peace of mind. But since mastectomy is a more extensive surgery, it requires more recovery time, is associated with more surgical complications and more emotional difficulties than lumpectomy. You may be relieved to hear less extensive surgery can also be safe and effective. Your decisions about breast surgery are personal and unique to your situation. Talk to your healthcare providers about your surgery options, and about the pros and cons of lumpectomy and mastectomy, so you can make the decision that’s best for you.

Quan, ML, Paszat, LF, Fernandes, KA, et al. The effect of surgery type on survival and recurrence in very young women with breast cancer. J Surg Onco. 115: 122–130, January 5, 2017; doi:10.1002/jso.24489.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.