Breast cancer surgery: does the patient’s age affect the outcomes?3 May 2016
Younger patients with breast cancer had more variability in outcomes with breast-conserving surgery as compared with older patients, including higher rates of local recurrence, distant metastasis, and mortality, a Danish study showed. In particular:
- Women 45 or younger had a 20-year local recurrence rate of 25% with breast conservation versus 11% for older women.
- Rates of local recurrence after mastectomy were 13% for younger patients and 3% for the older subgroup in the study population of 1,076 patients.
Younger patients had a 60% to 70% higher 20-year mortality risk with breast conservation, and local recurrence after breast-conserving surgery doubled the likelihood of distant metastasis. In contrast, the type of treatment did not significantly affect the same outcomes in older patients, reported Tinne Laurberg, MD, of Aarhus University Hospital in Denmark, at the European Society for Therapeutic Radiology and Oncology (ESTRO) in Turin, Italy.
“Breast-conserving therapy’s possible negative impact should be taken into account"
"Among the patients younger than 45, local recurrence was associated with distant metastasis, and young patients treated with breast-conserving therapy had an increased risk of death during the 20 years, either from their disease or from other causes, compared to those who underwent mastectomy," Laurberg commented. "When future treatment guidelines for young lymph-node negative patients are refined, the possibility of the negative impact of breast-conserving therapy on survival in these young women should be taken into account."
With respect to results in the older patients, the findings "are in line with long-term data reported from several randomized trials, confirming that it is safe to offer older, lymph-node negative patients breast conserving therapy and adjuvant radiation therapy."
Results of the data analysis
In an effort to inform decision making about surgical options for early, low-risk breast cancer, Laurberg and colleagues analyzed data from prospective cohort study sponsored by the Danish Breast Cancer Group. All of the patients had tumors less than 2 inches in diabetes and no axial lymph node involvement. Patients underwent breast-conserving therapy or mastectomy according to prevailing standards of care for the time period.
The data showed that 364 women had breast conservation and 712 had mastectomy. Overall, the rates of local recurrence at 20 years were 18% with breast conservation and 6.7% with mastectomy. However, significant differences emerged according to patient age.
Particularly, among women older than 45:
- Most local recurrences occurred within the first 5 years after surgery, whereas the time span covered 10 years in younger women.
- Local recurrence after breast-conserving therapy occurred during the first 10 years of follow-up in older patients but continued throughout the 20 years of follow-up in younger patients.
Among younger patients:
- The 14% absolute difference in local recurrence between breast conservation and mastectomy achieved statistical significance and local recurrence was a predictor of subsequent distant metastasis.
- Younger patients who opted for breast conservation had a significantly increased likelihood of dying of breast cancer or any cause as compared with women of the same age who had mastectomy.
- Local recurrence did not portend distant metastasis and breast conservation was not associated an increased risk of breast cancer death.
Younger women had higher risks of recurrence than older women
Two observations stood out for Amy C. Degnim, MD, of the Mayo Clinic in Rochester, Minn., who was not involved in the study. "First of all, women diagnosed with early-stage breast cancer before age 45 had higher risks of recurrence than older women, whether they underwent mastectomy or breast-conserving treatment," Degnim added.
"The second major finding was related to differences in recurrence based on the type of surgery. In the first 5 to 10 years after surgery, recurrence was similar between mastectomy and breast-conserving therapy for both younger and older women. However, with longer-term follow-up from 10 to 20 years after surgery, more recurrences were seen in the breast-conserving group compared to the mastectomy group."
The principal caveat for the study is the time frame, as the breast cancer diagnoses occurred from 1989 to 1998 when cancer treatment was not as effective as it is today, Degnim noted. "Nevertheless, these long-term data are very important, especially for young women who will live a long time after their cancer diagnosis and in whom the long-term risk of cancer recurrence is likely a major factor in their choice of surgical treatment," she added.
Source: MedPage Today