mastectomy and breast conservation treatment

There are inadequate data about optimal local treatment in the very young, particularly in light of the competing increased systemic risks. Limited evidence suggests that age younger than 35 years is associated with increased risk of recurrence after breast conserving treatment, and also possibly following mastectomy. When discussing options for local therapy, clinicians should offer
information about risk of recurrence based on the woman’s age and disease factors. Ultimately, all treatment decisions should rest with the woman.


Although some conflicting evidence exists,60,61 several studies have reported an independent association between very young age (less than 35 years) andincreases in local recurrence after breast conserving treatment.62-67 Breast cancers in younger women also carry a higher incidence of risk factors implicated in local recurrence, particularly high-grade, vascular invasion and extensive intraductal carcinoma (EIC),64,68-72 although the effect of EIC on local
recurrence has been shown by some to be offset by obtaining clear excision margins.73

Precise recurrence rates are uncertain due to the small numbers of younger women in any of these series, and differences between studies in age categories, tumour stage and grade, length of follow-up time, and statistical methods. Studies suggest the risk of recurrence for young women is approximately 12-30% per cent over a five- to 10-year period.64,68,74-76 Increased risk of recurrence appears to be highest for women under 30 years,67 and rapidly declines over age 35.72 There are similar higher rates of distant relapse in the very young age group.

High-grade tumours and vascular invasion are also implicated in increased risk of local recurrence after mastectomy, making such a choice no real advantage in terms of local control.72 Age younger than 35 years features as a risk factor for local recurrence after mastectomy too, and for some there will be a benefit for post-mastectomy radiotherapy.77 While one analysis has shown a survival advantage for mastectomy over breast conserving treatment for patients less
than 35 years,72 other data have not shown any survival advantage for more radical surgery.64,76,78