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Type of Treatment Impacts Rate of Recurrence in Young Women

July 28, 2009

Written By Arin Ahlum Hanson, MPH, CHES, Manager, Young Women’s Initiative
Reviewed By Silvia C. Formenti, MD

Young women with early-stage breast cancer can reduce the risk of locoregional recurrence by receiving radiation therapy, a recent study concludes.

This study of women aged 35 and under showed that those with stage II breast cancer who added radiation treatment to mastectomy had fewer recurrences than those who received surgery alone. Among women with stage I disease, adding chemotherapy improved the chances the cancer would not return near the original site.

This study, presented in the International Journal of Radiation Oncology, Biology, Physics, suggests very young women with stage II breast cancer may want to consider radiation therapy as part of their treatment plan.

Background

Previous research has shown that women diagnosed with breast cancer before age 35 are more likely to have a local recurrence of their breast cancer than older women with the same stage of breast cancer.

Researchers from the University of Texas M. D. Anderson Cancer Center in Houston wanted to find out if recurrence among young women could be attributed to the type of breast cancer treatment these women received. In women with stage I and stage II breast cancers, they compared three standard local therapies:

  • Breast-conserving therapy also called lumpectomy, which involves removing the cancer and a small margin of healthy tissue around it
  • Mastectomy or surgery to remove breast and
  • Mastectomy followed by radiation, a local treatment in which high-energy x-rays are targeted at any remaining cancer cells in the breast or lymph nodes

Study Design

This study examined the medical records of 652 women aged 35 years old or younger who had stage I and stage II breast cancer from 1973 to 2006. Of these women, 197 underwent breast-conserving therapy, 237 had a mastectomy and 234 received mastectomy with adjuvant (post-surgical) radiation.

This study was retrospective, meaning the researchers analyzed treatments that had already been given and looked for trends in the outcomes.

The researchers examined the ten-year locoregional recurrence rates for each of the three types of treatments. Locoregional recurrence is a return of the original breast cancer in the breast, the armpit, the skin or muscles of the chest wall or the surrounding lymph nodes. Cancer may return when cells present at the time of the original diagnosis are not removed during surgery, and subsequent treatments do not kill them.

Results

This study found that that younger people with breast cancer have higher locoregional recurrence rates than older people, a finding that has been reported in previous trials.

A new finding was that young women with stage II disease had better locoregional recurrence rates with mastectomy plus adjuvant radiation therapy compared with women who had breast-conserving therapy (lumpectomy and radiation to the remaining breast tissue) or mastectomy alone.

Adding radiation to mastectomy had a different effect depending on how the woman’s cancer was initially staged. Among those with stage II breast cancer, the rate of local recurrence at ten years of follow-up was 6 percent for young women who had mastectomy plus radiation therapy, compared to 18 percent in women with breast-conserving therapy and 23 percent for those who had mastectomy alone. This finding suggests that mastectomy with radiation works best in young women with stage II disease.

Among people with stage I disease, adding chemotherapy reduced local recurrence, with a recurrence rate of 14 percent compared to 28 percent among women who did not receive it.

Limitations

Since this was a retrospective study, where researchers consulted medical records rather than tracking participants over time, the study outcomes could have been influenced by hidden biases of healthcare providers toward certain treatment decisions. To decrease the likelihood of this bias, the treatment groups were chosen based on their similarities. Multivariate analysis, a type of statistical analysis that takes into account the differences among treatment traits in participants and compares their weight to one another, was also used to correct for this potential bias.

What Does This Study Mean for Me?

If you are 35 years old or younger, you may want to discuss with your provider how each treatment option may affect your chances of local recurrence.

Many factors go into your local treatment decisions, including the size of the tumor, how quickly it grows and whether it responds to hormonal or targeted therapies. To learn more about treatments for early-stage breast cancer, order a free copy of LBBC’s Guide for the Newly Diagnosed.

B. Beadle, et al. Ten-Year Recurrence Rates in Young Women with Breast Cancer by Locoregional Treatment Approach. International Journal of Radiation Oncology, Biology and Physics. Vol. 73. No. 3, pp 734-744.

Read more about recurrence rates among young women.

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