Young breast cancer patients who chose lumpectomies need indefinite follow-up

Young breast cancer patients who have breast conserving treatment are at higher risk of recurrence many years later than are older women who have the same treatment or women who have mastectomies, according to research published today (Monday 3 November) in Annals of Oncology.[1]

The researchers are definitely not saying that breast conservation treatment should be used less in younger patients, but they are saying that extra care should be taken with this treatment in younger women and that they should be followed up indefinitely. They also emphasised that the patients in their research study were diagnosed in the 1970s and therefore did not receive tamoxifen the anti-oestrogen drug now widely given to women whose tumours are hormone-sensitive.

The study, by a team from the Institut Gustave-Roussy and INSERM in Villejuif, France, followed 179 patients recruited to a trial in the 1970s for a mean duration of 22 years after diagnosis the longest follow-up of any trial comparing lumpectomy with breast irradiation against mastectomy. The 91 mastectomy and 88 conservation treatment patients were comparable in terms of age, tumour size (under 20 mm) and grade and the number of negative lymph nodes.

To verify the validity of their findings the researchers then analysed the results of 1,847 patients from the Institut Gustave-Roussy's database (632 who had conservation surgery and 1,215 who had mastectomies) who also had small tumours (under 25mm) and had followed a comparable radiotherapy protocol.

"What we found in the trial of 179 patients was that there was no difference over time on survival or on metastasis (secondary cancer)," said lead researcher Dr Rodrigo Arriagada. "The risk of local recurrence was actually five-fold less in the breast conservation patients during the first five years than in the mastectomy group. However, after five years it was 12-fold greater. The age range of the patients who developed local recurrence was s

Contact: Margaret Willson
European Society for Medical Oncology

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