Trends in surgical management and postoperative outcomes in adolescent and young adult breast cancer.
In a 2013–2023 surgical database study of 241,885 women with breast cancer, patients aged 18–39 underwent mastectomy and metastatic-setting surgery more often than older patients, with similar 30-day complication and mortality rates but a slightly higher reoperation rate.
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In a 2013–2023 surgical database study of 241,885 women with breast cancer, patients aged 18–39 underwent mastectomy and metastatic-setting surgery more often than older patients, with similar 30-day complication and mortality rates but a slightly higher reoperation rate.
Research significance
The evidence supports using these data as a contemporary perioperative benchmark for counseling young adult breast-cancer patients; it only suggests—and does not establish—that more extensive surgery is acceptably safe or improves cancer outcomes in this population.
Source abstract
BACKGROUND: Adolescent and young adult women (ages 18-39) with breast cancer face distinct clinical and psychosocial challenges, yet national perioperative data specific to this group remain scarce. This study characterizes surgical patterns and short-term outcomes in adolescent and young adult women with breast cancer compared with outcomes in older women using a large multi-institutional data set. METHODS: Women with a diagnosis of breast cancer undergoing lumpectomy or mastectomy with or without axillary surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2023. Patients were stratified by age (adolescent and young adult 18-39 vs ≥40). Baseline demographics, comorbidities, operative characteristics, and 30-day outcomes were compared using χ2 and t tests. RESULTS: Of 241,885 patients identified, 11,544 (4.8%) were in the adolescent and young adult group. The racial and ethnic makeup of these 2 groups was distinct, with 11.6% of young women identifying as Hispanic and 13.2% as Black, compared with 6.6% and 10.6% of older women, respectively (P < .001). Adolescent and young adult patients were healthier at baseline than older patients; however, a higher percentage of patients in the adolescent and young adult group had disseminated cancer (3.2% vs 1.8%, P < .001). Adolescent and young adult patients were more likely to undergo mastectomy, including modified radical mastectomy, than their older counterparts (72.1% and 20.2% vs 42.5% and 10.6%, P < .001), resulting in longer operative times (177 ± 108 vs 110 ± 83 min) and longer hospital stays (median, 1.0 vs 0.6 days; P < .001). Despite this, 30-day complication rates were low and comparable between younger and older women (4.0% vs 3.9%, P = .69); reoperation was slightly higher in adolescent and young adult patients (4.0% vs 2.8%, P < .001), whereas mortality remained <0.1% in both groups. CONCLUSION: Adolescent and young adult women constitute a demographically distinct minority of breast-surgical patients who overwhelmingly undergo mastectomy for surgical management of their disease. Adolescent and young adult women were also more likely to undergo surgical resection in the metastatic setting. Despite this, perioperative outcomes for adolescent and young adult women are comparable to those of older women. These data provide the largest contemporary benchmark for counseling young patients and support the safety of aggressive surgical management in this patient population.