Studies Highlight Differences in Breast Cancer Surgery for Young Women

At the 2018 San Antonio Breast Cancer Symposium, researchers discussed how young women make decisions about breast surgery, as well as age-related breast cancer risks
Breast Cancer News
December 13, 2018
By: 
Eric Fitzsimmons

The American Association for Cancer Research awarded Ann Partridge, MD, MPH, of the Dana-Farber Cancer Institute, its 2018 Outstanding Investigatorinfo-icon Award at the San Antonio Breast Cancer Symposium for her significant contributions to breast cancer research, especially for young women. Dr. Partridge, who is a member of LBBC’s medical advisory board, spoke from the podium about differences in breast cancer among young women, recent research efforts, and work that still needs to be done. As Dr. Partridge noted, women who are young at diagnosisinfo-icon are more likely than older women to die of breast cancer and have lower quality of lifeinfo-icon.

Her talk shone a spotlight on issues of interest to young women, which included three studies given at the symposium. Two examined breast surgeryinfo-icon choices, with the first looking at how women chose surgery after getting treatments that made it possible to remove the tumorinfo-icon and not the whole breast. The second studied the effects of those surgeries on women’s quality of life in the future. And a third looked at finding the risk of breast cancer based on age to guide testing and medical decisions.

Many Choose Mastectomy Over Lumpectomy, Even When Less Surgery Works Well

Recent research suggests that some women select more surgeryinfo-icon when their doctors believe less surgery could work as well. Less surgery is sometimes possible after neoadjuvant therapyinfo-icon, when whole-body treatments like chemotherapyinfo-icon are given before surgery. There are a number of reasons neoadjuvant therapy may be given, but one possible benefit is that it may shrink a breast cancer tumorinfo-icon before surgery. When a tumor is large, mastectomyinfo-icon – surgery to remove the whole breast – is needed. But neoadjuvant therapy can sometimes shrink the cancer so doctors can offer lumpectomyinfo-icon – surgery that removes just the tumor and some tissueinfo-icon around it.

Researchers looked at data from the Young Women’s Breast Cancer Study, a group of 1,302 women age 40 or younger when diagnosed. They selected 315 women for the final results, all whose tumors were large enough to make them eligible for neoadjuvant therapy. Based on the features of their tumors before getting neoadjuvant chemotherapy

  • 26 percent could have lumpectomy
  • 17 percent were “borderline” eligible
  • 55 percent could not have lumpectomy

After getting neoadjuvant therapy, 42 percent of the group overall could have a lumpectomy. Yet only 25 percent chose to do so.

Researchers wanted to find out why those who were eligible for lumpectomy chose mastectomy anyway. They reported 40 percent of that group had a known hereditaryinfo-icon geneinfo-icon mutationinfo-icon or a history of breast cancer in their family. But the most common reason women chose mastectomy, for 53 percent, was personal preference. That suggested to the researchers that the women’s choice was driven by more than the features of the cancer.

As researchers take more interest in finding the right amount of treatment for different situations, they will look more closely into the reasons people decide to have more treatment. They will also look into the effects surgeries have on quality of lifeinfo-icon, so doctors can have informed discussions with those making choices about treatment.

Choice of Breast Surgery Could Impact Future Well-Being

Another study looked at how choice of surgeryinfo-icon impacts quality of lifeinfo-icon in the years after treatment among young women with breast cancer. Here researchers also used the Young Women’s Breast Cancer Study, sending participants the BREAST-Q, a questionnaire that measures quality of life, either as a stand-alone survey or as part of the 10-year follow-up packet sent to women in this group. The average time between diagnosisinfo-icon and taking the survey was just under 6 years.

BREAST-Q measures quality of life in six areas, but researchers focused on four:

  • satisfaction with breasts
  • psychosocialinfo-icon well-being
  • physical well-being
  • sexual well-being

They averaged scores and compared them among people who had different types of surgery: lumpectomyinfo-icon, unilateralinfo-icon mastectomyinfo-icon (removing just the breast with cancer) and bilateralinfo-icon mastectomy (surgery to remove both breasts). In BREAST-Q, higher scores are associated with better quality of life.

All three types of surgery scored similarly on physical well-being, but in breast satisfaction, psychosocial concerns and sexual well-being, lumpectomy was associated with a higher quality of life. Researchers also found that across participants, radiation therapyinfo-icon and unstable finances were associated with lower quality of life.

The study had limitations: most participants were white and financially stable. Also, the quality of life before a person gets surgery may affect which surgery they choose, which researchers couldn’t control for.

Still, the study found that choice of surgery had a lasting effect on quality of life. The presenters said doctors should discuss these effects with women making a decision about breast cancer surgery.

Estimating Breast Cancer Risk by Age

It helps to understand how hereditaryinfo-icon mutations, or geneinfo-icon mutations from your mother and father, can affect breast cancer risk, screeninginfo-icon and treatment. But these mutations are generally found in people who know they are at higher risk for breast cancer because of a family history, their own diagnosisinfo-icon at a young age, or other features tied to risk.

The CARRIERS study looked at the likelihood of mutations linked to breast cancer risk. Researchers estimated the risks of breast cancer by age and over a lifetime for people in the general population—people for whom we don’t have information about features that change their cancer risk.

The study found that frequency of mutations known for raising breast cancer risk was higher than expected in both women who had breast cancer and women without breast cancer (who served as controls):

  • 4.2 percent of women with breast cancer had a mutationinfo-icon
  • 1.6 percent of control participants had a mutation

It also found that women who diagnosed at a young age – in this study, defined as under 50 – were much more likely to have a mutation that raised their risk:

  • 7.3 percent of women diagnosed with breast cancer under 50 had a mutation linked to breast cancer risk
  • 1.8 percent of control participants under 50 did

The data from this study paints part of the picture for what presenters want to see developed for knowing risks based on populations and family history for gene mutations that are linked to breast cancer risk.

The researchers encouraged more research to be able to give women estimates of their risks over the next 5 or 10 years of their lives, if they have a mutation known to be linked to breast cancer. This would help them make informed decisions about treatment, they said.

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