• Hee Jeong Kim, Laura Dominici, Shoshana M Rosenberg, Yue Zheng, Linda M Pak, Philip D Poorvu, Kathryn J Ruddy, Rulla Tamimi, Lidia Schapira, Steven E Come, Jeffrey Peppercorn, Virginia F Borges, Ellen Warner, Hilde Vardeh, Laura C Collins, Rachel Gaither, Tari A King, and Ann H Partridge.
• Department of Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, South Korea.
• Ann. Surg. 2022 Jul 1; 276 (1): 173-179.

ObjectiveWe aimed to investigate eligibility for breast conserving surgery (BCS) pre- and post-neoadjuvant systemic therapy (NST), and trends in the surgical treatment of young breast cancer patients.BackgroundYoung women with breast cancer are more likely to present with larger tumors and aggressive phenotypes, and may benefit from NST. Little is known about how response to NST influences surgical decisions in young women.MethodsThe Young Women's Breast Cancer Study, a multicenter prospective cohort of women diagnosed with breast cancer at age ≤40, enrolled 1302 patients from 2006 to 2016. Disease characteristics, surgical recommendations, and reasons for choosing mastectomy among BCS-eligible patients were obtained through the medical record. Trends in use of NST, rate of clinical and pathologic complete response, and surgery were also assessed.ResultsOf 1117 women with unilateral stage I-III breast cancer, 315 (28%) received NST. Pre-NST, 26% were BCS eligible, 17% were borderline eligible, and 55% were ineligible. After NST, BCS eligibility increased from 26% to 42% (P < 0.0001). Among BCS-eligible patients after NST (n = 133), 41% chose mastectomy with reasons being patient preference (53%), BRCA or TP53 mutation (35%), and family history (5%). From 2006 to 2016, the rates of NST (P = 0.0012), clinical complete response (P < 0.0001), and bilateral mastectomy (P < 0.0001) increased, but the rate of BCS did not increase (P = 0.34).ConclusionWhile the proportion of young women eligible for BCS increased after NST, many patients chose mastectomy, suggesting that surgical decisions are often driven by factors beyond extent of disease and treatment response.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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