title: Feasibility of breast-conserving therapy for younger women with breast cancer.
abstract: OBJECTIVE
  To determine if breast-conserving therapy (BCT) consisting of segmentectomy, axillary lymph node dissection, and postoperative irradiation is a feasible approach to breast cancer in younger women, whose breast tissue is dense and whose tumors can be difficult to detect and successfully excise.
  
  
  METHODS
  We studied BCT in 59 women 35 years old or younger (mean age, 31.7 years) treated for breast cancer since 1982. Ninety percent of their cancers were palpable; 44% were not visible by mammography. Most (93%) had T1 or T2 lesions (< or = 5 cm). Invasive ductal carcinoma was the predominant histologic diagnosis (68%).
  
  
  RESULTS
  Segmentectomy with axillary dissection was the initial operative procedure for 39 (66%) of the 59 patients; of these, 21 (54%) had microscopically positive segmentectomy margins. Nine patients (23%) with diffusely positive segmentectomy margins and four patients (13%) with local recurrences after BCT required conversion to mastectomy. Three patients (8%) underwent reexcision to achieve negative margins. The 39 patients required a total of 22 additional surgical procedures for local control. Thirty-three (56%) of the 59 patients underwent mastectomy during the mean 68-month follow-up period; 20 (34%) underwent mastectomy as the initial definitive treatment. Reasons for primary mastectomy included multifocality or multicentricity (35%), large tumor size (30%), patient preference (15%), and occult primary tumor (10%). During the same time period, 474 (64%) of 745 women older than 35 years underwent BCT as treatment of breast cancer. Two percent required conversion to mastectomy and 1% required repeated excision. Twenty-four patients (5%) required mastectomy for local recurrence after BCT. After excluding mastectomies performed because of patient preference, significantly fewer older women required mastectomy to achieve local control (21% vs 50%, P < .001).
  
  
  CONCLUSIONS
  Breast-conserving therapy is significantly more difficult in younger women despite surgeon and patient commitment. Patients and physicians should be encouraged to consider BCT but should be aware of the potential difficulty in obtaining adequate local control and the possible need for additional operative procedures.
authors.affiliation: Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Saint John's Hospital and Health Center, Santa Monica, Calif, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Guenther
authors.forename: D M
authors.initials: DM
authors.lastname: Kirgan
authors.forename: A E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local; D010173:Palpation; D011182:Postoperative Care; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013997:Time Factors