From the July 2022 issue of HealthCare Business News magazine
The growing number of young women with breast cancer coupled with the lack of prospective data to guide their care fueled our interest in exploring the unique needs of this patient population. Under the guidance of my program director, mentor, and senior author, Dr. Lejla Hadzikadic-Gusic, I was given the opportunity to present our research at the American Society of Breast Surgeons (ASBrS) meeting earlier this year. The study was funded by the Sandra Levine Young Woman’s Program, a wonderful resource for not only patient education and support, but also for clinical researchers, providing a plethora of valuable information regarding young breast cancer patients in the form of a prospectively collected database.
The study included almost 600 women under age 40 diagnosed with breast cancer who underwent oncologic treatment, including surgery, at Atrium Health Levine Cancer Institute. Patients were followed over a five-year period. A tumor’s molecular biology provides important prognostic information; therefore, patients were stratified by hormone receptor (HR) and HER2 status. We asked the question: does type of surgery with either mastectomy or breast conservation impact overall survival in young patients with breast cancer?
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Our results echoed what was found in those landmark clinical trials — more aggressive surgery does not help young patients live longer. However, a national trend toward mastectomy, and even contralateral prophylactic mastectomy (i.e., surgical removal of a healthy breast) in young patients continues to persist. Our patient cohort demonstrated a similar tendency, with 64% undergoing mastectomy versus breast conservation (36%). This is in contrast with older patients in our practice, who routinely choose lumpectomy over mastectomy if they are considered to be an appropriate candidate for breast conservation.
Why do younger patients tend to undergo mastectomy?
This motivation is likely multifactorial, including clinician and patient-related factors, as well as influences from social media.
Some providers may hesitate to apply current guidelines to younger patients, and a mastectomy may ultimately be recommended based upon young age alone. In addition, it is not uncommon for our patients to request a mastectomy during initial consultation and claim that “removing it all” will provide them with peace of mind during their breast cancer journey. While a legitimate consideration, this thought process should be carefully investigated because some patients may overestimate their risk for cancer recurrence and erroneously conclude a mastectomy confers a survival benefit. Appropriate education must be provided in this situation to avoid the unnecessary morbidity from more extensive surgical procedures.