Christine V. PESTANA, Sally J. TRUFAN, Wei SHA, Courtney R. SCHEPEL, Michelle L. WALLANDER, Richard L. WHITE, Lejla HADZIKADIC-GUSIC
European Journal of Breast Health - 2026;22(2):171-183
Objective: Mastectomy rates are increasing in young patients despite few data supporting improved outcomes. We investigated the association between surgical approach and survival in young patients with breast cancer. Materials and Methods: Retrospective review identified women <=40 years old with operable, non-metastatic invasive breast cancer treated between 2010-2019. Cox proportional hazard analyses, stratified by hormone receptor and human epidermal growth factor receptor 2 (HER2) status, identified factors associated with increased risk of recurrence and death. Results: Of 588 patients, 65% underwent mastectomy and 35% breast conserving surgery (BCS). Median follow-up was 5.9 years. Overall recurrence and mortality rates were 15% and 12%, respectively. On multivariable analysis, black race [hazard ratio (HR), 2.14 (1.26-3.61), p = 0.005], lymphovascular space invasion (LVSI) [HR, 1.98 (1.17-3.36), p = 0.01], and extranodal extension [HR, 2.12 (1.09-4.12), p = 0.03] were associated with increased risk of death. Stage III disease [HR, 2.06 (1.05-4.03), p = 0.04] and LVSI [HR, 2.18 (1.43-3.32), p<0.001] were associated with increased risk of recurrence. Increasing age decreased the risk of death [HR, 0.94 (0.88-0.99), p = 0.02] and recurrence [HR, 0.95 (0.90-0.99), p = 0.02]. Mastectomy versus BCS did not impact recurrence [HR, 1.18 (0.73-1.92), p = 0.51] or overall survival (OS) [HR, 0.86 (0.46-1.58), p = 0.62] in the entire cohort. BCS was associated with increased risk of recurrence in the hormone receptor-/HER2+ subtype [HR, 9.06 (1.03-80.00), p = 0.047] but did not affect survival. Conclusion: OS does not differ by surgery type in young patients with breast cancer. Future research should focus on racial disparities in breast cancer care.
