an individual and often “nuanced” one.
There are many things for a woman to consider and discuss with her doctors, according to Teshome: the specific characteristics of her breast cancer, her personal risk of a future recurrence, and the potential effects of surgery choice on her long-term quality of life, to name a few.
Most of the time, breast cancer is diagnosed after the age of 50. But while the rate is low among women younger than 40, it is on the rise, Pestana shares, making it even more important to understand the impact of treatment choices on their long-term prognosis.
She points to the “Angelina Jolie effect,” where the actor’s revelation that she’d had a double mastectomy to cut her breast cancer risk has influenced other young women to choose that option as a breast cancer treatment.
What’s important to remember, Pestana says, is that Jolie carries a BRCA mutation that greatly increases the risk of breast cancer. For young women at average genetic risk, she adds, evidence is lacking that a double-mastectomy improves survival over breast-conserving surgery.
The new findings are based on 591 women younger than 40 who were treated for breast cancer between 2010 and 2019. Most had earlier, stage 1 or 2 breast tumors, and none had cancer that had spread throughout the body.
Close to two-thirds of the patients underwent a mastectomy, Pestana says, while the rest had a lumpectomy.
The researchers found that once other factors were taken into account — including the stage and aggressiveness of the cancer, and other treatments women received — the choice of lumpectomy or mastectomy had no bearing on survival odds.
Another treatment did, however: Among women with hormone-sensitive cancer, those who did not receive hormonal therapy were three times more likely to die than those who did receive it.
Talking with your care team
Both Pestana and Teshome stress the importance of “shared decision-making” between women and their care team — which means discussing the pros and cons of all treatments, as well as a woman’s personal values.
Ultimately, Pestana says, “patients must be comfortable with their decision, and their doctors should support an informed choice.”