Invited Speakers’ Abstracts / The Breast 21S1 (2012) S1–S9 S3

IN7

The woman’s perspective

G. Freilich*. Founding President of Europa Donna, London, UK

The impact of a breast cancer diagnosis in the under 40s is shattering.

5 to 7% of women diagnosed are in this age group, at a time of life

when they might be studying for a profession, seeking a life partner,

advancing in their career, or bringing up a young family. Every aspect

of their lives and the lives of those close to them, will be affected.

Diagnosis of breast cancer presents the young woman with a whole

range of challenges. In addition to the physical and existential

threats, there are the prospects of disfiguring surgery and complex

adjuvant treatment with its unpleasant side effects. She is also

at risk of psychological, familial, occupational, financial and social

problems. She will not be on the same wavelength as the far greater

number of older women with breast cancer, so is likely to feel alien

and isolated.

In addition to her drive to find the best possible treatment, critical

issuesmay include fertility, prematuremenopause, child care, coping

with occupational responsibilities and financial implications. All will

be painfully heightened in the case of a poor prognosis.

This presentation will consider concerns facing younger women,

including those with a significant family history of breast cancer

who may have an inherited gene and who will be faced with added

dilemmas and decisions relating to the pros and cons of genetic

testing and its potential effects on family relationships.

Session III. Staging of breast cancer in youngwomen

IN8

Emerging technologies

T. Gagliardi *. Aberdeen Royal Infirmary, Department of Radiology

Department, Aberdeen, UK

When imaging young women to detect breast cancer there are

mainly two challenging factors to consider. The increased density

of the breast tissue on the one hand side and the radiation

dose related to different imaging modalities especially in high

risk women on the other side. Dense breast tissue reduces the

sensitivity of mammography, with as few as 45% of cancers

visible in extremely dense breasts. Additional imaging for improved

sensitivity in young women with dense breast tissue is necessary

to overcome this limitation. Emerging technologies that improve

the application of digital mammography like tomosynthesis will be

discussed. Additional imaging with ultrasound for detection and

further characterisation is essential in assessing symptomatic and

screening asymptomatic women. Ultrasound elastography might

contribute to improved assessment. Minimising radiation dose

related to mammography is a desirable aim when scanning young

women. Microdose mammography might help achieving this goal.

Emerging technologies like dedicated breast computed tomography,

intravenous and dual energy subtraction mammography and

positron emission mammography will be briefly discussed.

Session IV. Loco-regional therapy. What shouldbe different in young women

IN9

Surgery in young women with breast cancer

O. Gentilini *. European Institute of Oncology, Breast Surgery

Department, Milan, Italy

Young age is an independent risk factor for increased local recurrence

after breast conserving surgery and radiotherapy without affecting

overall survival. Some of the histopathological characteristics such as

larger size, higher grade, presence of peripheral extensive intraductal

component, vascular embolies, and lymphoid stroma have been

related to a higher risk of local recurrence. Nevertheless, surgical

treatment of young patients presenting with invasive cancer – while

being tailored to the individual patient – should in general not differ

from that of older patients. Breast-conserving surgery followed by

radiotherapy offers the same survival benefits as modified radical

mastectomy in women with stage I or II breast cancer and should

therefore be considered as the first option whenever suitable. This

may be particularly relevant for young women with breast cancer.

Modern breast conserving surgery is aimed to remove the cancer

while excising the smallest possible volume of tissue. Besides, and

especially in young women, aesthetic outcomes and concept of

female identity need to be taken into account. Skin-sparing and

nipple-sparingmastectomy techniques seem to be ideal options both

from an oncological and a cosmetic point of view. Oncoplastic repair

techniques should be offered to patients treated by breast conserving

surgery in order to maximize cosmetic results whenever an obvious

postoperative asymmetry can be estimated. Immediate breast

reconstruction after mastectomy offers the same survival benefits

as mastectomy without reconstruction. The option of immediate

breast reconstruction should be discussed prior to surgery, ideally

by a multidisciplinary team, in order to consider the issues related

to possible indications for post-mastectomy radiotherapy.

Sentinel lymph node biopsy (SNLB) is the first choice of axillary

staging in patients with early breast cancer. There is no evidence

of an increased false negative rate or a worse outcome in young

patients undergoing SNLB. In youngwomen, indications for SNLB are

the same as in older patients. The procedure should be performed

according to national and institutional guidelines and young age

per se is not a reason to prefer axillary dissection over SNLB.

Surgical management of patients with minimal SLN involvement

is still matter of debate. In particular, no data are available for

this specific topic in young women. When isolated tumour cells

are found in the SLN, general agreement is not to perform ALND.

At the moment, the trend is moving towards minimizing axillary

surgery with sparing the axillary nodes even in the presence of

micrometastases in the SLN. Recent data from a randomized trial

enrolling patients of any age showed that ALND did not significantly

affect disease-free or overall survival of patients with clinical T1-T2

cN0 breast cancer and at the most two positive SLN treated with

lumpectomy, adjuvant systemic therapy, and tangential-field whole

breast irradiation. Therefore, avoidance of axillary dissection can and

should be discussed even in young patients with involved SLN who

will undergo breast conservation with whole-breast radiotherapy

and appropriate systemic treatment.

IN10

Loco-regional therapy: radiotherapy. What should be different

in young woman

F.A. Calvo*. Hospital General Universitario Gregorio Maranon, Madrid,

Spain

Breast cancer rarely occurs in women below the age of 40 years.

Evidence indicates that breast tumors in young women are a

distinct biologic, genetic and clinical entity. Data from various

sources indicate that diagnosis at such an age is associated with an

adverse prognosismainly because of amore aggressive presentation,

increased rates of locoregional relapse (LRR), and a lower overall

5-year survival than their older counterparts, characteristics that

warrant the use of better preventive and therapeutic options.

Currently, adjuvant radiotherapy is recommended for all women

following BCT or mastectomy. Recent evidence suggests that the

incidence of local breast tumor recurrences and failures may be