title: Factors Associated with Recurrence Rates and Long-Term Survival in Women Diagnosed with Breast Cancer Ages 40 and Younger.
abstract: Young age at breast cancer diagnosis has been associated with increased risk of recurrence and mortality. We reevaluated this assumption in a large, modern cohort of women diagnosed with breast cancer at age ≤40 years.
  
  
  
  We identified women with breast cancer at age ≤40 years at a single institution from 1996-2008. We assessed locoregional recurrence (LRR), distant recurrence, disease-free survival (DFS), and overall survival (OS), and correlated patient and tumor characteristics with outcomes.
  
  
  
  We identified 584 women aged ≤40 years with breast cancer. Median age was 37 years, and median follow-up was 124 months; 61.5 % were stages 0-I and 38.5 % were stages II-III. Overall, 57.4 % had lumpectomies and 42.5 % mastectomies. DFS was 93 % at 5 years and 84.5 % at 10 years. OS was 93 % at 5 years and 86.5 % at 10 years. On multivariate analysis, worse DFS was associated with positive nodes (p = 0.002); worse OS was associated with larger tumor size (p = 0.042). When stratified by lumpectomy versus mastectomy, there were no significant differences in survival or recurrence. For lumpectomy patients, DFS was 96 % at 5 years and 88 % at 10 years; OS was 96 % at 5 years and 89 % at 10 years. For mastectomy patients, DFS was 89.5 % at 5 years and 79 % at 10 years; OS was 90 % at 5 years and 83 % at 10 years. Lumpectomy LRR rates were 1 % at 5 years and 4 % at 10 years. Mastectomy LRR rates were 3.5 % at 5 years and 8.7 % at 10 years.
  
  
  
  Outcomes for women with breast cancer at age ≤40 years have improved. Lumpectomy recurrence rates are low, suggesting that lumpectomy is oncologically safe for young breast cancer patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Plichta
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Upahvan
authors.initials: U
authors.lastname: Rai
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Tang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Coopey
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Julliette M
authors.initials: JM
authors.lastname: Buckley
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Gadd
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Hughes
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. blsmith1@mgh.harvard.edu.|Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA. blsmith1@mgh.harvard.edu.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
mesh_terms: D000328:Adult; D017668:Age of Onset; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult