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Breast

Breast Poster Presentations 1

P4: Breast conserving therapy is a safe option for women under 40 diagnosed with breast cancer

Thursday, March 21, 2024

4:03pm – 4:09pm ET

Location: C110

Oral Poster Presenter(s)

Arith Ruth S. Reyes, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States

Submitter(s)

Arith Ruth S. Reyes, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States

Author(s)

Arith Ruth S. Reyes, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States
EL

Eunice Y. Lee, MD PhD

Resident physician
University of California, San Francisco, United States
CC

Courtney Connelly, MD

Resident physician
Columbia University Medical Center, United States
JW

Jonathan Wyrick, MD

Resident physician
Rutgers New Jersey Medical School, United States
Roshni Rao, MD

Associate Professor of Surgery
Columbia University Medical Center
New York, NY, United States
LS

Luona Sun, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States
BT

Bret Taback, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States
SU

Stacy K. Ugras, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States
LW

Lisa S. Wiechmann, MD

Assistant Professor of Surgery
Columbia University Medical Center, United States

Introduction: Breast cancer in premenopausal women has been increasing in incidence, while breast conserving therapy (BCT)—lumpectomy plus radiation— as local treatment for young women remains controversial. We report the breast cancer survival and recurrence rates of women under 40 undergoing BCT versus mastectomy at our institution.

Methods: We performed a retrospective review of all women diagnosed with breast cancer at ages 40 or younger between 1995-2020 at our institution. Overall survival and recurrence rates were compared for patients undergoing BCT and mastectomy. Data were obtained from an established tumor registry and chart review; multivariate analysis (MVA) was performed.

Results: Four hundred and fourteen (414) women (average age 35 years) were identified with median follow-up of 57 months. Forty six percent (46 %) of women had family history of breast cancer, 20% carried a BRCA pathogenic variant, 28% were nulliparous, and 12% presented with pregnancy-associated breast cancer. Distribution by subtype was: HR+/HER2- in 59%, HER2+ in 21%, and HR-/HER2-/triple negative breast cancer (TNBC) in 20%. Stage at time of diagnosis was: stage 0 (11%); stage 1 (33%); stage 2 (40%); stage 3 (13%), and stage 4 (3%). Neoadjuvant chemotherapy was administered to 42% of women per standard of care. Sixty four percent (64%) and 36% of women underwent mastectomy and BCT, respectively. Adjuvant radiation was administered to 68% of women (and all BCT patients). On univariate analysis, there was no difference in 5-year overall survival between patients treated with BCT and mastectomy (95% vs. 92%, p=0.32) whereas patients undergoing BCT had a lower recurrence rate (19% vs. 30%, p=0.02) and were slightly older (35.6 years old vs. 34.7 years old, p=0.04). The most common type of recurrence was distant metastasis (62%). On MVA, after controlling for stage, age, race, tumor grade, tumor subtype, multicentricity, presence of comorbidity, and presence of BRCA+, we identified decreased recurrence rates for patients who underwent BCT (β=-0.174, p=0.03) and no difference in mortality (β=-0.040, p=0.29). The findings on 5-year overall survival and recurrence between mastectomy and BCT remained consistent even after excluding inflammatory breast cancer.

Conclusions: In our cohort with 5-year survival data, BCT is a safe option for women under 40 diagnosed with breast cancer. Despite no survival benefit, young women with breast cancer undergo mastectomy more often than lumpectomy. Importantly, most recurrences are distant metastases, suggesting that in this as in the older patient population, mastectomy does not improve recurrence.

Learning Objectives:

Characterize clinical and pathologic features and treatment of breast cancer in young women.
Demonstrate survival and recurrence between breast conserving therapy and mastectomy in young women with breast cancer.
Identify clinical and pathologic features associated with undergoing mastectomy versus breast conserving therapy in young women with breast cancer.