Young women with locally advanced breast cancer who achieve breast conservation after neoadjuvant chemotherapy have a low local recurrence rate.

Young women with breast cancer have been shown to be at higher risk of local recurrence when choosing breast conservation (BCT) as compared with mastectomy. A recent report demonstrated a 10-year local–regional recurrence (LRR) rate of 17.7 per cent with BCT compared with a 5.7 per cent rate with mastectomy plus radiation for young women with Stage II breast cancer who had not undergone neoadjuvant chemotherapy.1 Additionally, the Milan trial demonstrated a higher rate of recurrence in women aged younger than 45 years undergoing BCT versus mastectomy (1.05 per 100 women-years vs 0.18 per 100 women-years).2 Other studies have shown that young women tend to have a poorer response to therapy, increased rates of LRR, and decreased overall survival (OS) when compared with older women.3 Higher rates of triple negative and Her2/neu-positive breast cancer in young women are thought to play a role in the more aggressive nature of breast cancer in young women.4, 5 Neoadjuvant chemotherapy is now an accepted modality of treating locally advanced breast cancer. Prior studies have shown comparable rates of disease-free survival (DFS) and OS in patients undergoing neoadjuvant therapy as compared with adjuvant therapy.6, 7 Additionally, neoadjuvant chemotherapy can be a means to convert patients with tumors too large for BCT to appropriate candidates for BCT if there is an adequate response. Many studies have demonstrated that there is no significant difference in LRR among patients who undergo BCT versus mastectomy after neoadjuvant therapy.8, 9 We hypothesized that neoadjuvant chemotherapy would select out a group of young women whose tumors are responsive to chemotherapy and who may have more acceptable rates of local recurrence with BCT despite their young age based on more favorable tumor biology.