Local treatment in young breast cancer patients: Recurrence, toxicity and quality of life

Local treatment options for early stage breast cancer include mastectomy or breast-conserving therapy (BCT), the latter consisting of local excision followed by radiotherapy. For all age groups, the risk of local recurrence after BCT is higher than after mastectomy, with similar survival rates. However, young age is a known risk factor for local recurrence and distant metastases after both BCT and mastectomy. Since local recurrence is possibly a source of distant spread by itself, no consensus exists, whether young women can be treated safely with BCT. Our study confirms that in young women with early stage breast cancer survival after BCT is similar to that after mastectomy. Furthermore, the occurrence of metastases after local recurrence is not directly associated with the type of local treatment.
At our department, radiotherapy as part of BCT consists of whole breast irradiation with an integrated boost to the tumour bed. The clinical outcome in terms of recurrence and survival was excellent with acceptable short-term toxicities. The local recurrence rate was 1.1% at 5 years, without differences between young and older women. Young age was no risk factor for worse quality of life 3 years after treatment. Quality of life of young breast cancer patients did not differ from that in young Dutch women without breast cancer. In conclusion, breast-conserving therapy is suitable for young women with early stage breast cancer, with excellent clinical outcome.