Breast conservation in patients of 35 years or younger
Authors: A.C. Voogd, G. van Tienhoven
Journal: Annals of Oncology (2004)

Young age is a negative prognostic factor in breast cancer, and a determinant for the development of local recurrence following breast-conserving treatment (BCT) of invasive carcinomas. The study by Arriagada et al. [1.Arriagada R. Le M.G. Guinebretiere J.M. et al.Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients.Ann Oncol. 2003; 14: 1617-1622Abstract Full Text Full Text PDF PubMed Scopus (151) Google Scholar], with a unique follow-up of >15 years, again confirmed that local recurrences occur much more frequently in younger patients treated with BCT compared with those who undergo mastectomy, and that the risk of a recurrence in the preserved breast is much higher than the risk of a new primary tumour in the contralateral breast. The authors conclude that results require confirmation in other randomised studies. Two years ago, we came to a similar conclusion, based on the pooled results of two randomised controlled trials of the European Organization of Research and Treatment of Cancer and the Danish Breast Cancer Cooperative Group [2.Voogd A.C. Nielsen M. Peterse J.L. et al.Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials.J Clin Oncol. 2001; 19: 1688-1697Crossref PubMed Scopus (454) Google Scholar]. In this study, the 10-year actuarial rate of local recurrence for patients ≤35 years old was 7% [95% confidence interval (CI) 0% to 16%] after mastectomy and 35% (95% CI 17% to 53%) after BCT. Younger patients also appeared to have an increased risk of distant disease, which was much more prominent after BCT. Thus the question arose whether local recurrence might be a source of distant spread in some very young patients. However, just like the other randomised trials comparing BCT and mastectomy, the small number of patients in the youngest age group did not allow us to find the answer to this question. We therefore agree with Arriagada and colleagues [1.Arriagada R. Le M.G. Guinebretiere J.M. et al.Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients.Ann Oncol. 2003; 14: 1617-1622Abstract Full Text Full Text PDF PubMed Scopus (151) Google Scholar] that more data are needed to determine the safety of breast conservation in patients ≤35 years old, and ways to reduce their risk of local recurrence. It is probable that future studies will reveal (genetic) factors that predict local recurrence more accurately. Another way to reduce the high risk of local recurrence in younger patients is to apply more effective treatment strategies. For instance, one might consider changing the radiation dose or techniques, or including one course of peri-operative chemotherapy, which has been demonstrated to reduce the risk of loco-regional recurrence by 50% in node-negative premenopausal patients <43 years of age [3.Elkhuizen P.H. van Slooten H.J. Clahsen P.C. et al.High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study.J Clin Oncol. 2000; 18: 1075-1083PubMed Google Scholar].