Should breast conservation be offered to young women with breast cancer?

A growing body of literature suggests that younger women with breast cancer have poorer outcomes including higher rates of local relapse compared to older women with similar disease features and treatment. This has been attributed to several factors including genetics, tumor biology, hormonal factors, and differences in competing risks and leads to questions and reservations regarding optimal management given the lack of randomized trial data explicitly focused on breast cancer treatment of younger women. Numerous randomized trials comparing breast conserving therapy (BCT; lumpectomy and radiation) to mastectomy for early stage breast cancer have convincingly demonstrated no detriment in overall survival to BCT [1–7]. Unfortunately, however, the relatively small number of young women on these trials and the lack of and/or conflicting subset analyses of the local relapse outcomes for young women treated on many of these trials makes it difficult to extrapolate these data to specifically address the efficacy of BCT for younger women. Such information would be of value because numerous retrospective reports have suggested that young women have high local recurrence rates after BCT compared to older women treated with BCT [2, 8–16]. To further complicate the existing analyses, reported local relapse rates are decreasing over time [17, 18] likely because the indications for effective systemic therapies are expanding, and understanding of the prognostic importance of factors not previously accounted for like tumor subtype is increasing. Both issues make it extremely difficult to interpret retrospective analyses regarding BCT for younger women treated today.