Younger women who undergo lumpectomy to remove
noninvasive breast cancer cells are significantly more likely to
experience a recurrence than older patients, in part, because
physicians may not be removing enough breast tissue during surgery,
according to a study conducted by researchers at William Beaumont
Hospital in Michigan.
Over a 13-year period, lead author Frank Vicini, md, and his research
team followed 146 patients who were treated at the Michigan hospital
with breast-conserving therapy (lumpectomy plus radiation) for ductal
carcinoma in situ (DCIS). They found that younger patients (ie, those
under 45 years old) had a significantly greater rate of cancer
recurrence (26.1%) than older women (8.6%). This higher rate of
recurrence among younger women was due to surgery that may not have
cleared the margins.
Extent of Surgery, Not Age, Increases Recurrence
When the researchers looked more closely at the 95 patients who had a
second lumpectomy due to concerns that some cancerous tissue
remained, they found that the 31 younger patients in this group more
frequently had less tissue initially removed than the older patients.
Thus, the factor most associated with a poor outcome was not age but
the extent of the surgery. Bigger surgeries offered better
results, said Vicini. He speculated that concern for appearance
may have been a primary reason for the removal of too little tissue.
However, Vicini stressed that DCIS can present differently in younger
patients. In younger women, cancer can be spread over a
slightly larger area in the breast because the tissue is more dense
and has more ducts. As women age, ducts are replaced by fat, he
says. The surgery needs to meticulously clear the margins in
both younger and older women.