In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women < 40 Years of Age? A Multi-Institution Study
Menée à partir des données de registres américains des cancers portant sur 853 patientes âgées de moins de quarante ans et atteintes d'un cancer du sein diagnostiqué entre 1975 et 2013, cette étude multicentrique évalue, du point de vue de la récidive locorégionale, de la survie sans récidive et de la survie globale à 10 ans, l'équivalence d'un traitement conservateur et d'une mastectomie en fonction de la période de diagnostic (avant ou après 2000)
Purpose : Mastectomy (M) is often recommended for women < 40 years of age with breast cancer as young women were under-represented in the landmark trials comparing breast conservation therapy (BCT) and M. We hypothesize that in the modern treatment era BCT and M have equivalent local control in young women. Patients and Methods : Breast cancers between 1975 and 2013 in women < 40 years were collected from the tumor registries of two large healthcare systems in XXXX. Kaplan Meier estimates and Cox proportional hazards models were used to analyze freedom from locoregional recurrence (FFLR), overall survival (OS), and relapse free survival (RFS). Results : This analysis identified 853 BCT candidates. When comparing BCT and M with a diagnosis after 2000, FFLR, RFS, and OS were all similar. FFLR at 10 years 94.9% versus 92.1% for BCT and M, respectively (P = 0.57). For those diagnosed after 2000 who received BCT, FFLR and RFS were improved compared to women diagnosed prior to 2000 (p<0.05), while OS (p = 0.46) was similar. Among those who underwent M, FFLR, OS, and RFS were significantly improved (p<0.05) with diagnosis after 2000. Conclusions : FFLR for young women < 40 years of age has significantly improved for BCT and M over time. If treated after 2000, BCT appears to be safe and equivalent to M at 10 years in terms of FFLR, OS, and RFS.