Mastectomy or Lumpectomy? Reassuring New Data for Young Women

WebMD

3 days ago

July 23, 2025 – Young women diagnosed with breast cancer may not need to choose aggressive surgery to reduce recurrence risk.
New research suggests the likelihood of cancer recurring (coming back) in the same breast or nearby lymph nodes isn't related to her choice of surgical treatment – removing either the cancerous tissue (lumpectomy) or one or both breasts (mastectomy).
And for women 40 and under with invasive but not incurable cancer, recurrence risk across the board was "low" – just 5.6% over 10 years.
"Many young women with breast cancer choose to have bilateral mastectomies even if they may be a candidate for a smaller surgery," said study author Laura S. Dominici, MD, a breast surgeon at Dana-Farber Cancer Institute and Mass General Brigham in Boston. "We know survival isn't impacted by this choice, but historically, young women were felt to have higher risk for local recurrence and tend to have more 'aggressive' breast cancers."
The new findings, published Wednesday in JAMA Surgery, suggest that "women cannot make a bad choice," Dominici said. "A woman who wants to keep her breast isn't trading off a cancer outcome to do so."
Of the more than 1,100 people in the study, 30% had lumpectomy, 26% had a single mastectomy, and 43% had bilateral mastectomy. When researchers analyzed surgical treatment alongside cancer subtype – such as whether it was related to hormones or certain genes – they found no significant differences in recurrence rates.
Researchers attributed the low risk to advances in cancer treatments, which have become more targeted. Breast cancer patients in the study were diagnosed between 2006 and 2015, and they received optimal treatment after surgery – meaning breast cancer in young women may not be as likely to come back as older research suggested.
Does This Research Apply to Me?
The study included women age 40 or younger with stage I, II, or III breast cancer of any subtype – meaning hormone receptor-positive, triple negative, or any ERBB2 (formerly HER2) genetic status. If that describes you, you may want to talk to your doctor about it.
The researchers excluded women with stage IV breast cancer (which has already spread to other parts of the body) and women with stage 0, or ductal carcinoma in situ or DCIS.
"The results do require some caution in their generalizability because the patients were not from diverse populations, with nearly 85% non-Hispanic White women," Julie A. Margenthaler, MD, wrote in a commentary published with the study. Margenthaler was not involved in the study and is a breast cancer surgeon at WashU Medicine in St. Louis.
What Type of Recurrence Did This Study Look For?
It looked for local or regional recurrence (that is, in the same breast or surrounding lymph nodes), but not distant recurrence – when breast cancer returns in a distant part of the body like the brain or bones. That's a stage IV diagnosis, which is usually considered treatable but not curable.
What About BRCA?
About 1 in 10 women in the study had known BRCA genetic involvement, and most had mastectomies. "Women do not have to have a mastectomy in this setting, but many of them consider it," Dominici said. "Mastectomies will reduce the risk for future cancers (for which patients with BRCA mutations are at higher risk) but will not reduce risk for recurrence of the current cancer. A woman with BRCA mutation having lumpectomy should be doing high-risk screening with mammogram and MRI."
Does This Mean I Should Get a Lumpectomy?
When deciding what breast cancer surgery to have, you need to consider physical, emotional, and psychological factors, said Dominici, who is also a professor at Harvard Medical School.
"There is no 'right' answer," she said, "and it is often hard for women to both appreciate and consider the short- and long-term impacts of the different surgeries."
Lumpectomy may not be an option for some women with cancer in a significant portion or multiple areas of the breast, Dominici said.
"Surgery is one important part of treatment, but systemic therapy and radiation are also key to lower risk for recurrence," she said.