Younger Women with Early Breast Cancer Have a Higher Rate of Recurrence

Younger Women with Early Breast Cancer Have a Higher Rate of Recurrence than Older Women

Younger women who are treated for ductal carcinoma in situ, an early stage of breast cancer, have a higher rate of recurrence (return of cancer) than older women, say researchers at the William Beaumont Hospital in Royal Oak. A partial explanation for this finding may be that younger women often have surgery that removes less of the breast tissue than older women do.

Ductal carcinoma in situ (DCIS) is the earliest stage of breast cancer. DCIS is frequently diagnosed by screening mammography (or mammogram), which shows small areas of calcification in the breast. The time it would take for DCIS to progress to a more advanced, or invasive, breast cancer is estimated to be 5 to 8 years. However, treated early, DCIS is highly curable. With complete removal of the breast (mastectomy), cure rates range from 98 to 99%. The combination of a more breast-conserving surgery (lumpectomy), radiation therapy, and hormonal therapy produces cure rates comparable to those achieved with mastectomy. Even when DCIS recurs (returns) after breast conserving therapy, a mastectomy can cure the majority of patients. One question that has been raised is whether a person’s age influences the outcome of treatment for breast cancer.

Researchers evaluated the effect of age in 146 patients with DCIS who had been treated with lumpectomy and radiation therapy at least 5 years previously. Of the 146 patients, 12% had a recurrence of cancer in the same breast and 5% had developed DCIS or invasive breast cancer in the opposite breast after 5 years. Nine percent developed DCIS or invasive breast cancer in the opposite breast after 10 years. No patients had died after 5 years, and less than 1% had died after 10 years. When examining these findings with regard to the patients’ ages, researchers found that 26% of women younger than age 45 years had a recurrence of DCIS or invasive breast cancer in the same breast, compared to only 8.6% of older women. Upon further analysis, the results showed that these recurrences were associated with the surgical removal of smaller volumes of breast tissue in the younger women. The researchers noted that this finding suggests, but does not prove, that removing less of the breast may be associated with more recurrences in younger women. However, they also pointed out that virtually all recurrences, if detected early, can still be cured with mastectomy.

The researchers concluded that younger women with DCIS had a 20% risk of local recurrence (return of cancer in the breast) after treatment with lumpectomy and radiation therapy. They suggested that the extent of surgery may, in part, explain this risk, and that adequate surgery for DCIS is important. (Journal of Clinical Oncology, Vol 18, No 2, pp 296-306, 2000)

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