Early Lumpectomy Doesn't End Cancer Risk
Lumpectomy Safe, but Long-Term Vigilance a Must in Young Women
The Key: Long-Term Follow-Up continued...
"This is important because younger patients prefer to keep their breasts," Arriagada says. "You have to give them this information, knowing that they have to continue follow-up care for the long term -- 20-25 years. This is the most important message. Because in most cancer centers they finish follow-up by specialists in 10 years. We say they should continue with specialists and, after eight to 10 years, start making a special effort to detect recurrent or new cancers."
Pamela N. Munster, MD, a medical oncologist at Moffitt Cancer Center in Tampa, Fla., specializes in the treatment of young women with breast cancer. She says it's not clear from Arriagada's study that the tumors seen 10 years after lumpectomy are really recurrent cancer.
"We really have to investigate why a women can be 35 and have breast cancer," Munster tells WebMD. "What is predisposing this young woman to breast cancer? Whatever made you susceptible to have breast cancer at a young age makes you more susceptible in the long run. That may be more important than whether the woman had a lumpectomy for her original tumor."
Munster strongly agrees with Arriagada that young women successfully treated for breast cancer should continue seeing a breast cancer expert. It's essential for their own health. And it's important for the next generation of women, too.
"It is really important that women under 40 with breast cancer be proactive in getting treatment at a major center where they have access to genetic counseling," Munster says. "They should think about becoming part of studies that look at this young group. We don't even know whether these young breast cancers respond to our treatments in the same way as breast cancers in older women. We need to study this, and young women can help by joining clinical trials."
Too Conservative Breast Conservation?
The lumpectomy procedure in the Arriagada study -- conducted in the 1970s -- used what surgeons call a 2-cm free margin. That is, the surgeons removed 2 cm of cancer-free tissue surrounding the tumor.
That's large by today's standards. But given the risk of recurrence in his study, Arriagada recommends a conservative approach to breast conservation.