title: Should women younger than 40 years of age with invasive breast cancer have a mastectomy? 15-year outcomes in a population-based cohort.
abstract: OBJECTIVE
  Optimal local management for young women with early-stage breast cancer remains controversial. This study examined 15-year outcomes among women younger than 40 years treated with breast-conserving surgery plus whole-breast radiation therapy (BCT) compared with those treated with modified radical mastectomy (MRM).
  
  
  METHODS
  Women aged 20 to 39 years with early-stage breast cancer diagnosed between 1989 and 2003 were identified in a population-based database. Primary outcomes of breast cancer-specific survival (BCSS), overall survival (OS) and secondary outcomes of local relapse-free survival (LRFS), locoregional relapse-free survival (LRRFS), and distant relapse-free survival (DRFS) were calculated using Kaplan-Meier methods and compared between BCT and MRM cohorts using log-rank tests. A planned subgroup analysis was performed on patients considered "ideal" for BCT (ie, T1N0, negative margins and no extensive ductal carcinoma in situ) and in whom local therapy may have the largest impact on survival because of low systemic risk.
  
  
  RESULTS
  965 patients were identified; 616 had BCT and 349 had MRM. The median follow-up time was 14.4 years (range, 8.4-23.3 years). Overall, 15-year rates of BCSS (76.0% vs 74.1%, P=.62), OS (74.2% vs 73.0%, P=.75), LRFS (85.4% vs 86.5%, P=.95), LRRFS (82.2% vs 81.6%, P=.61), and DRFS (74.4% vs 71.6%, P=.40) were similar between the BCT and MRM cohorts. In the "ideal" for BCT subgroup, there were 219 BCT and 67 MRM patients with a median follow-up time of 15.5 years. The 15-year BCSS (86.1% vs 82.9%, P=.57), OS (82.6% vs 82.9%, P=.89), LRFS (86.2% vs 84.2%, P=.50), LRRFS (83.1% vs 78.3%, P=.24), and DRFS (84.8% vs 79.1%, P=.17) were similar in the BCT and MRM cohorts.
  
  
  CONCLUSIONS
  This population-based analysis with long-term follow-up confirmed that women younger than 40 years treated with BCT had similar 15-year outcomes compared with MRM. Young age alone is not a contraindication to BCT.
authors.affiliation: BC Cancer Agency, Vancouver Centre.
authors.forename: Jeffrey Q
authors.initials: JQ
authors.lastname: Cao
authors.affiliation: BC Cancer Agency, Vancouver Island Centre.
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.affiliation: Tom Baker Cancer Centre, University of Calgary.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.affiliation: BC Cancer Agency, Centre for the North.
authors.forename: Robert
authors.initials: R
authors.lastname: Olson
authors.affiliation: Centre Hospitalier de L'Universite de Montreal.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Coulombe
authors.affiliation: BC Cancer Agency, Vancouver Centre.
authors.forename: Mira
authors.initials: M
authors.lastname: Keyes
authors.affiliation: BC Cancer Agency, Vancouver Centre.
authors.forename: Lorna
authors.initials: L
authors.lastname: Weir
authors.affiliation: BC Cancer Agency, Vancouver Centre.
authors.forename: Karen
authors.initials: K
authors.lastname: Gelmon
authors.affiliation: BC Cancer Agency, Vancouver Island Centre.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bernstein
authors.affiliation: Cancer Control Research, BC Cancer Agency.
authors.forename: Ryan
authors.initials: R
authors.lastname: Woods
authors.affiliation: BC Cancer Agency, Breast Cancer Outcomes Unit.
authors.forename: Caroline
authors.initials: C
authors.lastname: Speers
authors.affiliation: BC Cancer Agency, Vancouver Centre. Electronic address: styldesl@bccancer.bc.ca.
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult