High mastectomy rates in young and very young patients with breast cancer. Are they justified?

Abstract

We read with interest the article from Szollar and colleagues published in November 2019 issue, entitled “A long-term retrospective comparative study of the oncological outcomes of 598 very young (≤35 years) and young (36–45 years) breast cancer patients” [ [1] Szollára A. Újhelyia Polgár C. al A long-term retrospective comparative study of the oncological outcomes of 598 very young (≤35 years) and young (36–45 years) breast cancer patients. Eur J Surg Oncol. 2019; 45: 2009-2015 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ]. We commend the authors on a well written article which focuses on a common and challenging problem, such as breast cancer in young women. The exact definitions of “young patient” and “very young patient”, when dealing with the diagnosis of breast cancer, remain uncertain. The authors proposed a quite acceptable “cut-off” (35 years) based on concrete data regarding prognostic factors and survival outcomes. This concept would be strengthened if similar results were confirmed by further studies. Interestingly, the surgical management was not different in the two groups (p = 0.103). Mastectomy was used in more than half of very young patients group (51.6%), and slightly less often in the young group (44.9%). Considering that in both groups the main proportion of patients had T1 tumours, and also considering the fact that selected patients with T2 tumours nowadays receive breast conservation surgery, one can argue that rates of mastectomy can be seen as somewhat higher than expected. Increasing rates of mastectomy represent a new scenario that breast specialists have to face in current practice. While this trend has been well acknowledged in the US, the situation in European countries remains poorly defined [ [2] Mahmood U. Hanlon A.L. Koshy M. et al. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 2013; 20: 1436e43 Crossref Scopus (143) Google Scholar , [3] Fancellu A. Sanna V. Cottu P. et al. Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients. Breast. 2018; 39: 1-7 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar ]. Mastectomy in young women is often considered as the intervention of choice, regardless of the tumour size, because of concerns caused by the worst prognosis of the disease in that age group. In addition, it is well known that local recurrences after breast conservation are more frequent in young women. Nonetheless, the last ESO-ESMO guidelines for the management of young women with breast cancer, recommend that breast conserving surgery should be considered as the option of choice when proper indication exists, because breast conservation followed by radiotherapy offers the same survival outcomes as mastectomy [ [4] Paluch-Shimon S. Pagani O. Partridge A.H. Abulkhair O. et al. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast. 2017; 35: 203-217 Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar ]. Patients’ choice also plays an important role in the decision-making process, and the choice of mastectomy is often fueled by unjustified anxiety and fear of worst prognosis related to breast conservation. We believe that the multidisciplinary team should strive to provide the patient with exhaustive information, based on scientific evidence, in order to reach a shared and motivated decision on management of her breast cancer. Moreover, recent reports suggesting a possible survival benefit in patients receiving breast conserving surgery compared to mastectomy, would be taken into account in the near future especially when dealing with young women [ [5] Gentilini O.D. Cardoso M.J. Poortmans P. Less is more. Breast conservation might be even better than mastectomy in early breast cancer patients. Breast. 2017; 35: 32-33 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar ]. A long-term retrospective comparative study of the oncological outcomes of 598 very young (≤35 years) and young (36–45 years) breast cancer patientsEuropean Journal of Surgical OncologyVol. 45Issue 11PreviewBreast cancer diagnosed in very young women (VYWBC; ≤35 years) and young women (YWBC; 36–45 years) tends to be heterogeneous. The current study aimed to compare the clinicopathological characteristics and long-term clinical outcomes between YWBC and VYWBC subgroups. Full-Text PDF