Breast cancer is much more common in older women than it is in younger women. When it does occur in younger women, it tends to be a more aggressive cancer; however, younger women generally respond well to chemotherapy. Treatment often consists of surgery followed by chemotherapy for women with cancer that has spread to the lymph nodes under the arm (advanced localized breast cancer) and surgery alone for women with smaller cancers that have not spread to the lymph nodes under the arm (localized breast cancer). Now, researchers in Denmark say that all young women who have localized breast cancer should receive chemotherapy after surgery.

Treatment options for persons with

advanced localized breast cancer usually involves surgery to remove the cancer and surrounding tissue (lumpectomy) or to remove the breast (mastectomy). To kill any cancer cells that may remain and to prevent a recurrence (return) of the cancer, treatments such as chemotherapy, radiation therapy, and/or hormone therapy are usually administered after surgery. However, for persons with localized breast cancer that is small in size or that has not spread to the lymph nodes, the likelihood of recurrence is thought to be low, and chemotherapy is not routinely given after surgery. Danish researchers recently evaluated the treatment results of more than 10,000 young women and found that chemotherapy after surgery may indeed be the best treatment approach for all young women with localized breast cancer.

The researchers evaluated the treatment outcomes for 10,356 women who were younger than 50 years of age at the time of their diagnosis with breast cancer. They found that women who were thought to have “low-risk” breast cancer were not given chemotherapy after surgery, and ultimately had a higher risk of dying than women the same age who did receive chemotherapy. This increased risk of dying in younger women who do not receive chemotherapy was also greater compared with that of older women. The researchers also discovered that the younger the woman’s age, the higher was the risk of having a cancer recurrence when chemotherapy was not given. These researchers concluded that, although breast cancer can be more aggressive in younger women, this aggressiveness can be countered effectively by providing chemotherapy after surgery to all young women with localized breast cancer.

These findings suggest that all young women with localized breast cancer may benefit from chemotherapy after surgery. An editorial piece that accompanied the publication of this study further recommended that all young women with localized breast cancer receive chemotherapy with adriamycin or epirubicin as well as 5 years of hormone therapy with tamoxifen for those in whom the cancer cells are found to have hormone receptors. Young women with localized breast cancer may wish to talk with their doctor about the risks and benefits of receiving chemotherapy after surgery, with or without hormone therapy. (British Medical Journal, Vol 320, No 7233, pp 474-479, 2000)

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