Breast Cancer Research and Treatment

, Volume 140, Issue 3, pp 577–585 | Cite as

Impact of primary local treatment on the development of distant metastases or death through locoregional recurrence in young breast cancer patients

  • E. J. Bantema-Joppe
  • E. R. van den Heuvel
  • L. de Munck
  • G. H. de Bock
  • W. G. J. M. Smit
  • P. R. Timmer
  • W. V. Dolsma
  • L. Jansen
  • C. P. Schröder
  • S. Siesling
  • J. A. Langendijk
  • J. H. Maduro
Epidemiology
First Online:
Received:
Accepted:

Abstract

In this study, we tested the hypothesis whether breast conserving therapy (BCT) compared with mastectomy is associated with a negative outcome in terms of distant metastases or death (DMD) and investigated the relation between locoregional recurrence (LRR) and DMD in young breast cancer (BC) patients. This study included a consecutive series of 536 patients ≤40 years of age at diagnosis with pathological T1N0-3M0 BC, treated between 1989 and 2005. A multistate survival model was used to evaluate the influences of local treatment and LRR on DMD, adjusted for potential prognostic factors. Patients were treated with mastectomy (N = 213) or BCT (N = 323). Median age at diagnosis was 36.3 years, with a median follow-up of 9.0 years. The 10-year actuarial cumulative incidence of DMD was 30.6 % after mastectomy and 26.3 % after BCT (P = 0.04). In total, 81 (15 %) LRRs were observed. After BCT, patients had a threefold higher risk of LRR than after mastectomy (HR 2.9; 95 % CI 1.6–5.3). Patients with LRR had a higher risk of DMD compared with patients without LRR (HR 5.5; 95 % CI 2.1–14.5). However, BCT was not negatively associated with DMD-after-LRR (HR 0.47; 95 % CI 0.2–1.1, BCT vs mastectomy). In conclusion, although LRR significantly affected DMD, the increased risk of LRR after BCT compared with mastectomy did not lead to a worse DMD outcome in BC patients ≤40 years of age.

Keywords

Breast cancer Therapy Young Locoregional recurrence Radiotherapy Breast conserving therapy Mastectomy 
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Notes

Acknowledgments

The authors thank the registration of the Comprehensive Cancer Center the Netherlands for the collection of the data for the Netherlands Cancer Registry, and all participating hospitals for providing the data. Katelijne Volmer and Paulien Westhoff are also thanked for the additional data collection.

Disclosures

None.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • E. J. Bantema-Joppe
    • 1
  • E. R. van den Heuvel
    • 2
  • L. de Munck
    • 3
  • G. H. de Bock
    • 2
  • W. G. J. M. Smit
    • 4
  • P. R. Timmer
    • 5
  • W. V. Dolsma
    • 1
  • L. Jansen
    • 6
  • C. P. Schröder
    • 7
  • S. Siesling
    • 3
    • 8
  • J. A. Langendijk
    • 1
  • J. H. Maduro
    • 1
  1. 1.Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  2. 2.Department of EpidemiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  3. 3.Department of Registration and ResearchComprehensive Cancer Centre the NetherlandsUtrechtThe Netherlands
  4. 4.Radiotherapeutic Institute FrieslandLeeuwardenThe Netherlands
  5. 5.Department of Radiation OncologyIsala ClinicsZwolleThe Netherlands
  6. 6.Department of Surgical OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  7. 7.Department of Medical OncologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  8. 8.Department of Health Technology and Services ResearchMIRA Institute of Biomedical Technology and Technical Medicine, University of TwenteEnschedeThe Netherlands

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