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Some Breast Cancer Recurrences May Be More Likely Among Younger Women (dateline January 19, 2000)


A widely publicized study published in the Journal of Clinical Oncology reported that cases in which breast cancer returns (recurs) after treatment may be more common among younger women. Researchers studied the long-term outcomes of 146 Michigan patients who had breast-conserving therapy ( lumpectomy and radiation) for ductal carcinoma in situ (DCIS) an early stage breast cancer, between 1980 and 1993. The results of the study revealed that women under 45 years of age showed a higher rate of cancer recurrence than older women in part because their lumpectomies did not remove enough breast tissue. It is also known that breast cancer is typically more aggressive in younger patients.

Frank Vicini, MD, of the William Beaumont Hospital in Royal Oak, Michigan, led the study. Dr. Vicini theorized that some of the patients in the study might not have received "adequate" lumpectomies because younger women are more likely to be concerned with the cosmetic results of breast surgery than older women. Lumpectomy, the surgical removal of a breast lump and a surrounding margin of normal breast tissue, has become a common treatment for early stage breast cancer. Unlike mastectomy (surgical removal of the affected breast), lumpectomy preserves the physical aspect of the breast. An "adequate" lumpectomy, according to Dr. Vicini, removes at least one centimeter of normal breast tissue surrounding the breast lump.

Of the 146 patients in the study, 35% experienced a return of breast cancer after surgery. Of the patients whose breast cancer returned, 38 (75%) were under age 45 while only 13 (35%) were over age 45. When examining 95 patients in the study, the researchers found that the majority of younger patients had less breast tissue removed during lumpectomy than the older patients. Among the younger women who had adequately sized lumpectomies, there was no increased rate of cancer recurrence compared with older women. However, Dr. Vicini’s study included breast cancer patients who had lumpectomies twenty years ago when the drug tamoxifen was not used to further reduce the risk of cancer recurrence. Younger women who have had lumpectomies within the past 10 years are not likely to be at any greater risk of their cancer returning than older women, said Dr. Vicini.

During the 1990s, surgeons determined sufficient margins of normal breast tissue that should be removed in addition to the breast lump to protect against breast cancer recurrence. In general, the removal of a margin of one centimeter of normal breast tissue is adequate to guard against the return of breast cancer. Most patients who undergo lumpectomy also have six to seven weeks of radiation therapy to help kill off any remaining cancer cells.

Dr. Vicini noted that the size of lumpectomy was only one of the factors that may have contributed to the higher rate of cancer recurrence among women under age 45 in the study. Researchers have known for years that breast cancer is usually more aggressive in younger women than in older women. Breast tissue in younger women is usually more dense and less fatty than the breast tissue of older women.

DCIS is the most common type of non-invasive breast cancer; over 40,000 cases of DCIS are diagnosed in the United States each year. Though the rate of cancer recurrence is slightly higher among women who choose lumpectomy over mastectomy as surgical treatment, the survival rate for DCIS is nearly 100% regardless of treatment.

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