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Does surgical approach impact overall survival for young women with breast cancer?

July 06, 2022
Women's Health
From the July 2022 issue of HealthCare Business News magazine

By Dr. Christine V. Pestana

While we know that one in eight women will eventually develop breast cancer, we also know that the diagnosis in those under 40 years of age is relatively uncommon, with less than five percent of women at average-risk being affected.

However, we’re seeing an increasing number of young women being diagnosed with breast cancer. Why?

The short and frustrating answer is: we don't know. But what we do know with certainty is that compared with older patients, young women are burdened with more advanced disease and unfavorable tumors, notoriously known to increase the risk of both cancer recurrence and death. Multiple factors likely contribute to this striking difference in outcomes among age groups, however, in the absence of a known genetic mutation, we are currently unable to explain to younger patients why they are plagued by more complex and unpredictable breast cancer.

Surgery is a key component in the treatment of early-stage breast cancer. In general, options include a mastectomy, or removal of the entire breast gland and breast conservation, in which only the tumor is removed with a rim of normal tissue (i.e., lumpectomy). This goes hand-in hand with postoperative radiation therapy. In the setting of invasive disease, a sentinel lymph node procedure is also performed, in which several lymph nodes under the axilla (or armpit, for lack of a better word) are removed to check for local spread of disease.

Historically, a mastectomy was considered the standard of care in the management of patients with breast cancer. This surgical procedure is not only a longer, more extensive undertaking when compared to a lumpectomy, but is also associated with an increased risk of complications including wound infection, bleeding, and chronic pain. While it seems intuitive that removal of all breast tissue will help improve cancer-related outcomes, a large body of surgical literature supports that breast conservation is equivalent to mastectomy with respect to survival. In other words, more aggressive surgeries will not help breast cancer patients live longer. This paradigm shift from a more radical surgical approach to an outpatient procedure revolutionized the field of breast cancer, providing an opportunity to safely de-escalate surgical options without compromising the goals of cancer care.

However, there is an important caveat to consider when interpreting this information — these recommendations are based on studies that predominantly excluded young women. Which raises the question: can these conclusions be safely applied to younger patients, who we know suffer from more aggressive disease and less favorable outcomes?

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