Surgical Management of Young Women with High-Risk Breast Cancer Receiving Neoadjuvant Systemic Therapy on the I-SPY2 Trial

BACKGROUND: Mastectomy rates in women with breast cancer are higher in younger women than in older women. The impact of this more extensive surgery on overall survival (OS) and locoregional recurrence in younger women is unknown, especially after neoadjuvant systemic therapy (NST). This study evaluated surgical management and outcomes of patients aged ≤ 45 versus > 45 years enrolled in multicenter NST clinical trial, I-SPY2.0 (NCT01042379, PMID 37325931). METHODS: We conducted a secondary data analysis comparing locoregional treatment in patients aged ≤ 45 versus > 45 years with clinical or molecular high-risk clinical stage II-III breast cancer treated from April 2010 to June 2022. Multivariate Cox proportional hazards models were used to evaluate associations between type of breast surgery with OS and locoregional recurrence-free interval by age group and tumor receptor subtype. RESULTS: Of 1737 patients, 698 (40.2%) were aged ≤ 45 years. There were no significant differences in patient or tumor characteristics or residual cancer burden distribution between age groups. Although breast-conserving surgery was significantly less common in younger women (36.8% vs 48.5%, p < 0.001), surgery type was not associated with OS or locoregional recurrence-free interval for patients aged ≤ 45 years. CONCLUSIONS: Greater extent of breast surgery was not associated with improved outcomes in women aged ≤ 45 years. Choice of surgical procedure in the management of breast cancer is multifactorial, but young age alone does not warrant mastectomy following NST.

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Publication Details

Journal
Annals of Surgical Oncology
Published
2026-08-03
DOI
https://doi.org/10.1245/s10434-026-20153-x
Citations
1
Primary Topic
Breast Cancer Treatment Studies
Type
article
Field-Weighted Citation Impact
4.70

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article

Surgical Management of Young Women with High-Risk Breast Cancer Receiving Neoadjuvant Systemic Therapy on the I-SPY2 Trial

M.C. Lee, Jennifer F. Tseng, A.J. Chien, S.B. Kesmodel et al.
1 citations
Annals of Surgical Oncology
Breast Cancer Treatment Studies
4.70
article

Surgical Management of Young Women with High-Risk Breast Cancer Receiving Neoadjuvant Systemic Therapy on the I-SPY2 Trial

M.C. Lee, Jennifer F. Tseng, A.J. Chien, S.B. Kesmodel, N.D. Prionas, Kyle Hewitt, A.M. Demichele, L.F. Allen, A.M. Wallace, C. A. M. Sauder, W.F. Symmans, M. Golshan, R. A. Shatsky, L. J. van't Veer, H. M. Kuerer, K. A. Ahmed, E. E. Burke, R. A. Mukhtar, J. C. Boughey, C. Yau, J. Tchou, T. J. Li, J. Perlmutter, C. R. Reyna, F. Ito, C. J. D. Isaacs, N. K. Taunk, L. A. Gutnik, I. M. Kang, C. A. Arciero, J. M. Chandler, N. T. Jaskowiak, K. Dimitroff, M. Howard-McNatt, A. Schwer, M. C. Moran, D. Yee, R. Rao, J. E. Jordan, L. M. Postlewait, H. S. Rugo, N. M. Hylton, L. J. Esserman
article en
1 citations

Abstract

BACKGROUND: Mastectomy rates in women with breast cancer are higher in younger women than in older women. The impact of this more extensive surgery on overall survival (OS) and locoregional recurrence in younger women is unknown, especially after neoadjuvant systemic therapy (NST). This study evaluated surgical management and outcomes of patients aged ≤ 45 versus > 45 years enrolled in multicenter NST clinical trial, I-SPY2.0 (NCT01042379, PMID 37325931). METHODS: We conducted a secondary data analysis comparing locoregional treatment in patients aged ≤ 45 versus > 45 years with clinical or molecular high-risk clinical stage II-III breast cancer treated from April 2010 to June 2022. Multivariate Cox proportional hazards models were used to evaluate associations between type of breast surgery with OS and locoregional recurrence-free interval by age group and tumor receptor subtype. RESULTS: Of 1737 patients, 698 (40.2%) were aged ≤ 45 years. There were no significant differences in patient or tumor characteristics or residual cancer burden distribution between age groups. Although breast-conserving surgery was significantly less common in younger women (36.8% vs 48.5%, p < 0.001), surgery type was not associated with OS or locoregional recurrence-free interval for patients aged ≤ 45 years. CONCLUSIONS: Greater extent of breast surgery was not associated with improved outcomes in women aged ≤ 45 years. Choice of surgical procedure in the management of breast cancer is multifactorial, but young age alone does not warrant mastectomy following NST.

Annals of Surgical Oncology
University of Southern California (US), Atrium Health Wake Forest Baptist (US), University of Minnesota (US), Loyola University Medical Center (US), The University of Texas MD Anderson Cancer Center (US), Emory University (US), University of California, San Francisco (US), Georgetown University (US), University of Utah (US), Columbia University Irving Medical Center (US), Ohio Department of Health (US), University System of Ohio (US), Moffitt Cancer Center (US), University of Alabama at Birmingham (US), Yale University (US), University of California San Diego (US), University of Chicago (US), Quantum Leap Healthcare Collaborative (US), City of Hope (US), University of Miami Hospital (US), Mayo Clinic in Arizona (US), Gemini Computers (United States) (US), University of Pennsylvania (US), University of California, Davis (US)
U.S. Department of Defense, Breast Cancer Research Foundation, Amgen, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, Sanofi, Gilead Sciences, American Society of Clinical Oncology, F. Hoffmann-La Roche, Helsinn, Regeneron Pharmaceuticals, Intuitive Surgical, Ionis Pharmaceuticals, City of Hope, Relay Therapeutics, Merit Medical Systems, Seagen, National Institutes of Health, Genentech, University of California, San Francisco, National Cancer Institute, Daiichi Sankyo Europe
Good health and well-being
Openalex Percentile: Top 4%
Breast Cancer Treatment Studies
4.70
DOIOpen Access PDFOpenAlex
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