WOMEN 35 YEARS OF AGE OR YOUNGER HAVE HIGHER LOCOREGIONAL RELAPSE RATES AFTER UNDERGOING BREAST-CONSERVATION THERAPY

Background: The use of breast conservation therapy (BCT) in young wome n with invasive breast cancer is controversial. To examine this import ant issue, rates of locoregional recurrence and overall survival after BCT were compared in two subsets of women-those less than or equal to 35 years of age at time of surgery and their older counterparts. Stud y Design: We examined records of 290 women with invasive breast cancer treated with BCT (local excision and axillary dissection) at Memorial Sloan-Kettering Cancer Center between 1984 and 1993. These included 8 7 patients less than or equal to 35 years of age at time of surgery an d 203 randomly selected patients >35 years of age. Followup was obtain ed from physician charts or patient interviews, or both. Complete data on clinicopathologic factors, recurrence, and survival were available on 280 patients. Results: Median followup from time of operation was 8.0 years for the entire group. Mean tumor size was 2.0 cm for women l ess than or equal to 35 years and 1.8 cm for those >35 (p = 0.07). Inv olved nodes were found in 48% of the young patients and 36% of the old er patients (p 0.08). Within our study group (n = 280), 274 patients r eceived radiotherapy. Women less than or equal to 35 years of age had significantly higher rates of locoregional recurrence and lower rates of overall survival than their older counterparts (p < 0.05). On multi variate analysis, these results were independent of tumor size and nod al status. A history oflocoregional relapse, however, was not associat ed with a higher rate of death from disease in the entire cohort or in either age group. Conclusions: Patients less than or equal to 35 year s of age undergoing BCT for invasive breast cancer are at higher risk for locoregional recurrence and death from disease. The higher mortali ty rate, however, does not appear to be a direct result of locoregiona l relapse. Additional study is required to verify these findings. Curr ently, young age does not exclude patients from BCT in our practice. B ut, we include this data as part of the informed consent process. (J A m Coll Surg 1998;187;1-8. (C) 1998 by the American College of Surgeons ).