Skip to main content

Advertisement

SpringerLink
Log in

Factors Affecting Outcome for Young Women with Early Stage Invasive Breast Cancer Treated with Breast-conserving Therapy

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

Young women have worse outcome following breast-conserving therapy (BCT) than do older patients in many studies. We examined how clinical, pathological, and treatment factors affect these results.

Methods

Between 1993 and 1999, 130 patients age 40 years or younger with stage I or II breast cancer were treated with BCT. The median radiation dose to the tumor bed was 61 Gy; 80% of patients received chemotherapy; and 29% of 72 patients with estrogen-receptor positive tumors received tamoxifen. Median follow-up was 93 months.

Results

Fifteen patients (12%) developed an ipsilateral breast tumor recurrence (IBTR), with or without other simultaneous failure sites. The Kaplan-Meier 5- and 8-year actuarial rates were 8% and 14%, respectively. The 74 patients with grade 3 tumors had a higher IBTR rate (8-year actuarial rate, 18%) than the 54 patients with grade 1–2 lesions (7%) (P = 0.09). Six patients developed contralateral breast cancers, and 17 developed distant metastases (DM). The 8-year actuarial rates for freedom-from-DM, relapse-free survival, and overall survival were 85%, 72% and 96%, respectively.

Conclusion

This represents one of the largest series of young women treated with BCT, using an approach similar to current practice. The IBTR rate was substantially lower than in many past studies, but still higher than would be expected for older women. This appeared largely due to the increased rate of IBTR in patients with grade 3 tumors. If this observation is confirmed, further analysis of this subgroup may lead to ways of reducing the risk of IBTR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

EIC:

Extensive intraductal component

LVI:

Lymphovascular invasion

ER:

Estrogen receptor protein

RT:

Radiation therapy

References

  1. Nixon AJ, Neuberg D, Hayes DF (1994) Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancers. J Clin Oncol 12:888–894

    PubMed  CAS  Google Scholar 

  2. Albain KS, Allred DC, Clark GM (1994) Breast cancer outcome and predictors of outcome: are there age differentials? J Natl Cancer Inst Monogr 16:35–42

    PubMed  Google Scholar 

  3. Agrup M, Stal O, Olsen K, Wingren S (2000) C-erbB-2 overexpression and survival in early onset breast cancer. Breast Cancer Res Treat 63:23–29

    Article  PubMed  CAS  Google Scholar 

  4. Marcus JN, Watson P, Page DL, et al (1994) Pathology and heredity of breast cancer in younger women. J Natl Cancer Inst Monogr 16:23–34

    PubMed  Google Scholar 

  5. de la Rochefordiere A, Asselain B, Campana F, et al (1993) Age as prognostic factor in premenopausal breast carcinoma. Lancet 341:1039–1043

    Article  Google Scholar 

  6. Aebi S, Gelber S, Castiglione-Gertsch M, et al (2000) Is chemotherapy alone adequate for young women with estrogen-receptor-positive breast cancer? Lancet 355:1869–1874

    Article  PubMed  CAS  Google Scholar 

  7. Zhou P, Recht A (2004) Young age and outcome for women with early-stage invasive breast carcinoma. Cancer 101:1264–1274

    Article  PubMed  Google Scholar 

  8. Greene FL, Page DL, Fleming IA et al (eds) (2002) AJCC Cancer Staging Manual, 6th Edn. New York, Springer

  9. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathol 19:403–410

    Article  CAS  Google Scholar 

  10. Schnitt SJ, Connolly JL (1992) Processing and evaluation of breast excision specimens: a clinically oriented approach. Am J Clin Pathol 98:125–137

    PubMed  CAS  Google Scholar 

  11. Schnitt SJ, Abner A, Gelman R, et al (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 74:1746–1751

    Article  PubMed  CAS  Google Scholar 

  12. Nixon A, Schnitt S, Connolly JL et al (1992) Relationship of patient age to pathologic features of the tumor and the risk of local recurrence for patients with stage I or II breast cancer treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys 24(suppl 1):221 (abstr)

    Google Scholar 

  13. Kurtz JM, Jacquemier J, Amalric R, et al (1990) Why are local recurrences after breast conserving therapy more frequent in young patients? J Clin Oncol 8:591–598

    PubMed  CAS  Google Scholar 

  14. Vrieling C, Collette L, Fourquet A, et al (2003) Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer 39:932–944

    Article  PubMed  CAS  Google Scholar 

  15. Voogd AC, Nielsen M, Peterse JL, et al (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 19:1688–1697

    PubMed  CAS  Google Scholar 

  16. DiBiase SJ, Komarnicky LT, Schwartz GF, et al (1998) The number of positive margins influences the outcome of women treated with breast preservation for early stage breast carcinoma. Cancer 82:2212–2220

    Article  PubMed  CAS  Google Scholar 

  17. Park CC, Mitsumori M, Nixon A, et al (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18:1668–1675

    PubMed  CAS  Google Scholar 

  18. Holli K, Isola J (1997) Effect of age on the survival of breast cancer patients. Eur J Cancer 33:425–428

    Article  PubMed  CAS  Google Scholar 

  19. Early Breast Cancer Trialists’ Group (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–2106

    Google Scholar 

  20. Kroman N, Holtveg H, Wohlfahrt J, et al (2004) Effect of breast conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer 100:688–693

    Article  PubMed  Google Scholar 

  21. Fisher B, Anderson S, Bryant J, et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus radiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  22. Veronesi U, Cascinelli N, Mariani L, et al (2002) Twenty-year follow up of a randomized study comparing breast conservative surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  23. Sarrazin D, Le MG, Arriagada R, et al (1989) Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol 14:177–184

    Article  PubMed  CAS  Google Scholar 

  24. Jacobson JA, Danforth DN, Cowan KH, et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911

    Article  PubMed  CAS  Google Scholar 

  25. Van Dongen JA, Voogd AC, Fentiman IS, et al (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92:1143–1150

    Article  PubMed  Google Scholar 

  26. Blichert-Toft M, Rose C, Andersen JA, et al (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: Six years of life-table analysis. J Natl Cancer Inst Monogr 11:19–25

    PubMed  Google Scholar 

  27. Matthews R, McNeese M, Montague E, et al (1988) Prognostic implications of age in breast cancer patients treated with tumorectomy and irradiation or mastectomy. Int J Radiat Oncol Biol Phys 14:659–663

    PubMed  CAS  Google Scholar 

  28. Bouvet M, Babiera GV, Tucker SL, et al (1997) Does breast conservation therapy in young women with breast cancer adversely affect local disease control and survival rate? The M.D. Anderson Cancer Center Experience. Breast J 3:169–175

    Article  Google Scholar 

Download references

Acknowledgements

Support provided by the Joan and Haim Eliachar Endowment Fund for Breast Cancer Research, Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston. We also thank Ms. R. Amezquita for her extraordinary administrative support for this project.

Author information

Authors and Affiliations

  1. Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA, USA

    Ping Zhou

  2. Department of Biostatistics, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Shiva Gautam

  3. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA

    Abram Recht

  4. BROF, 375 Longwood Avenue, Boston, MA, 02215, USA

    Ping Zhou

Authors
  1. Ping Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiva Gautam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abram Recht
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ping Zhou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, P., Gautam, S. & Recht, A. Factors Affecting Outcome for Young Women with Early Stage Invasive Breast Cancer Treated with Breast-conserving Therapy. Breast Cancer Res Treat 101, 51–57 (2007). https://doi.org/10.1007/s10549-006-9268-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-006-9268-y

Keywords

Search

Navigation