Mastectomy vs. Lumpectomy: Survival Rates Equal for Younger Breast Cancer Patients

New research presented at the annual meeting of the American Society of Breast Surgeons indicates that for high-risk patients under age 45, breast-conserving surgery is as effective as a mastectomy in maintaining long-term survival and preventing cancer recurrence.

The findings address a trend where younger women with breast cancer undergo mastectomies at higher rates than older women. A mastectomy typically involves the removal of the entire breast, while breast-conserving surgery, such as a lumpectomy, is less invasive and spares the breast tissue.

According to the study’s lead author, Jennifer Tseng, MD, medical director of breast surgery at City of Hope Orange County in Irvine, California, women facing a choice between these two surgical paths should not be scared about selecting the wrong surgery.

Study Findings on High-Risk Patients

The research analyzed data from over 1,700 participants involved in the I-SPY2 clinical trial. The cohort consisted of patients with high-risk stage 2 and 3 breast cancer who received medical therapy before undergoing surgery between 2010 and 2022.

Researchers noted that there were no significant differences in tumor features, race, or ethnicity between the participants under age 45 and those over age 45. However, a stark difference appeared in the choice of surgery: 63 percent of women under 45 underwent a mastectomy, compared to 37 percent of women over 45.

Despite the higher frequency of mastectomies in the younger group, the data showed that the more invasive procedure did not provide superior outcomes in terms of overall survival or the rate of cancer recurrence.

“Younger patients lived just as long and stayed cancer-free in the breast and surrounding tissues at similar rates between both types of surgery,”

Dr. Jennifer Tseng

Factors Influencing Surgical Decisions

Dr. Tseng described the decision between breast-conserving therapy and mastectomy as multifactorial. The choice often depends on specific clinical factors, including the size of the tumor or a family history that indicates an elevated genetic risk.

In some clinical cases, a mastectomy remains necessary to ensure all cancerous tissue is removed. For women with BRCA gene mutations, a mastectomy may be chosen due to the higher risk of developing additional cancers, according to Kahyun Yoon-Flannery, DO, chief of women’s oncology and breast surgery at AtlantiCare in Egg Harbor Township, New Jersey.

Beyond medical necessity, psychological and lifestyle factors often drive the decision for younger patients. Dr. Yoon-Flannery noted that anxiety or fear regarding the possibility of cancer recurrence, or the prospect of needing repeated biopsies and imaging, can lead younger women to opt for a mastectomy.

some patients choose mastectomy to avoid radiation therapy. Radiation is typically a standard component of breast-conserving therapy and can carry various side effects. While some women who undergo a mastectomy may still require radiation, it is less likely than in breast-conserving cases, according to Heather Richardson, MD, a breast cancer surgeon at Bedford Breast Center in Beverly Hills, California.

Consulting with Surgeons

Medical professionals emphasize that there is generally no single right or wrong choice between the two surgical options. Instead, the decision should be based on the individual patient’s priorities and clinical profile.

Dr. Tseng suggests that patients review the advantages and disadvantages of each approach with their surgical team. Key priorities for patients to consider include:

• The desire to reduce the risk of new cancers
• The preservation of breast sensation
• The preference for a less extensive surgical procedure
• The goal of decreasing overall recovery time
• The pursuit of breast reconstruction options

Dr. Richardson added that a wide array of treatment options now exist, even for aggressive forms of breast cancer. She noted that the final decision is a very personal choice to make, and that the optimal path for one woman may be unsuitable for another, even if their medical situations are identical.

The research has been presented at the American Society of Breast Surgeons annual meeting but has not yet been published in a peer-reviewed medical journal.