Younger Women With Breast Cancer Tend to Get Mastectomies. Is This Always the Best Option?

Women with some forms of breast cancer may need to choose between mastectomy (a surgery that typically removes the entire breast) or a less-invasive surgery that spares the breast, such as lumpectomy.

Younger women with breast cancer tend to have higher rates of mastectomy than breast-conserving surgery compared with older women.

But a new study presented at the annual meeting of the American Society of Breast Surgeons found that both options were equally successful at keeping high-risk patients under age 45 alive longer and cancer-free.

“Women given a choice between breast-conserving surgery or mastectomy by their breast surgeon should not be scared about selecting the wrong surgery,” says Jennifer Tseng, MD, medical director of breast surgery at City of Hope Orange County in Irvine, California, and the study’s lead author.

Study Looked at Patients With High-Risk Stage 2 and 3 Breast Cancer

The research, which has not yet been published in a medical journal, involved over 1,700 participants from the I-SPY2 clinical trial for patients with high-risk stage 2 and 3 breast cancer who were treated with medical therapy before surgery from 2010 to 2022.

There were no significant differences in race, ethnicity, or tumor features between women younger than 45 and those older than 45.

The researchers found that women under 45 had higher mastectomy rates compared with those over 45 (63 percent versus 37 percent). But for the younger women, mastectomy was not superior to breast-conserving surgery in terms of overall survival or cancer recurrence.

“Younger patients lived just as long and stayed cancer-free in the breast and surrounding tissues at similar rates between both types of surgery,” Dr. Tseng says.

Why Younger Patients May Have Higher Mastectomy Rates

The choice between a mastectomy or breast-conserving surgery is a “multifactorial” decision, based on factors such as tumor size or a family history suggesting an elevated genetic risk, Tseng says.

In some instances, younger women may need a mastectomy to remove all the cancer, she explains.

Younger women with breast cancer who have BRCA gene mutations may choose a mastectomy because they have a higher rate of another cancer, says Kahyun Yoon-Flannery, DO, chief of women’s oncology and breast surgery at AtlantiCare in Egg Harbor Township, New Jersey, who was not involved with the new study.

For other younger women, the choice to have a mastectomy may be driven by anxiety or fear of needing additional imaging or biopsies, having worse outcomes, or experiencing a cancer recurrence, she adds.

Younger women may also choose mastectomy to avoid radiation, which is typically a part of breast-conserving therapy and may have side effects, says Heather Richardson, MD, a breast cancer surgeon at Bedford Breast Center in Beverly Hills, California, who was not involved with the research. (Some women who’ve opted for mastectomy will still need radiation, but it’s less likely.)

How to Approach a Conversation With Your Breast Cancer Surgeon

“Deciding between breast-conservation therapy or mastectomy can be difficult, and there is typically not a ‘right’ or ‘wrong’ choice,” says Tseng.

Tseng suggests women review the pros and cons of each approach with their surgeons.

Patients should also consider their priorities for surgery, such as reducing the risk of a new cancer, preserving breast sensation, having less surgery, decreasing recovery time, and pursuing breast reconstruction, Tseng says.

Today, many treatment options exist, even for aggressive breast cancers, Dr. Richardson adds. With surgery, she says, “It’s a very personal choice to make, and what is right for one woman may be a very poor choice for another, even if they’re facing the same situation.”