Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer.
OBJECTIVE
To evaluate survival outcomes of young women with early-stage breast cancer treated with breast conservation therapy (BCT) or mastectomy, using a large, population-based database.


METHODS
Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients, ages 20 to 39 years old, diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007, who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable and matched pair analyses were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy.


RESULTS
A total of 14,764 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range, 0.5-17.9 years). After we accounted for all patient and tumor characteristics, multivariable analysis found that BCT resulted in OS (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83-1.04; p = 0.16) and CSS (HR, 0.93; CI, 0.83-1.05; p = 0.26) similar to that of mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5-, 10-, and 15-year OS rates for BCT and mastectomy were 92.5%, 83.5%, and 77.0% and 91.9%, 83.6%, and 79.1%, respectively (p = 0.99), and the 5-, 10-, and 15-year CSS rates for BCT and mastectomy were 93.3%, 85.5%, and 79.9% and 92.5%, 85.5%, and 81.9%, respectively (p = 0.88).


CONCLUSIONS
Our analysis of this population-based database suggests that young women with early-stage breast cancer have similar survival rates whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options and should not choose a mastectomy based on the assumption of improved survival.
Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA. usama.mahmood@gmail.com
Usama
U
Mahmood
Christopher
C
Morris
Geoffrey
G
Neuner
Matthew
M
Koshy
Susan
S
Kesmodel
Robert
R
Buras
Saranya
S
Chumsri
Ting
T
Bao
Katherine
K
Tkaczuk
Steven
S
Feigenberg
D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000401:mortality; D016555:Matched-Pair Analysis; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000401:mortality; D018426:SEER Program; D015996:Survival Rate; D055815:Young Adult