In Breast Cancer Awareness Month, Claire Keeton salutes the courage of survivors When I was a teenager, my mother got breast cancer. She had double mastectomies, radiotherapy and toxic chemotherapy.My father was a professor of medicine and my older sister and brother were medical students. I remember my sister putting up a drip for my mom in the bedroom while she was on chemotherapy. After enduring harsh therapies, my mom went into remission and lived until 72.You always think your parents are old when you are young but she was only in her 40s then - younger than my sister and I are now.I thought of my mother when I saw research published this year that compared the survival rates of women with early breast cancer who choose a lumpectomy (removing just the tumour) with those who had a mastectomy.story_article_left1The study found that women under 45 who had a mastectomy had a much better chance of survival than those who chose breast-conserving therapy (lumpectomy).The risk of death for the younger women who chose breast-conserving therapy was roughly two-thirds higher than those who had a mastectomy, reported the lead scientist, Dr Tinne Laurberg, from Aarhus University Hospital in Denmark.Breast cancer expert and surgeon Dr Carol-Ann Benn, who has helped to set up onco-reconstructive centres in private and government hospitals in Joburg, said of the findings: "There is no doubt that strong evidence exists that in those young women who undergo breast-saving surgery, and who get a local recurrence, their survival is worse."The question is, 'Why?' Is this about the type of surgery or rather the biology of the cancer? Is this about the type of oncology treatment or radiation treatment received?"Benn said that young women did get breast cancer and it was foolhardy not to investigate symptoms in young women."Careful documentation about their age and tumour details at time of diagnosis is critical," she said."What treatment they receive should always be discussed in a multidisciplinary environment, with careful discussions around fertility and choice. At the end of the day, the body and the disease belong to the patient. The clinician should advise, recommend, and respect right of choice."The Danish study conducted over 20 years had an unusually high proportion of young women and it found:Women with early-stage breast cancer that had not spread to the lymph nodes and who opted for a breast-conserving therapy with radiation therapy had a 13% higher risk of developing a local recurrence of their cancer over a 20-year period than women who had a mastectomy and no radiation therapy;Local recurrence doubled the risk of the cancer spreading elsewhere in the body (metastasis), raising the risk of death by two-thirds;story_article_right2Among women over 45 there was no link between local recurrence and the risk of metastasis, and there was no difference in the proportion of these women who died after BCT or mastectomy.Laurberg said that their results for older women were in line with other trials "confirming that it is safe to offer older, lymph-node negative patients breast-conserving therapy and adjuvant radiation therapy".Professor Philip Poortmans, president of the European Society for Radiotherapy and Oncology, said the findings among younger women might be a warning about the potential risks associated with "less aggressive breast cancer treatments".On the positive side, he noted that there had been "a remarkable decrease in the rate of local recurrences after breast-conserving therapy even for young patients".Every day I feel lucky that my sister and I have not had breast cancer and salute the courage of women, like my mom and colleagues, who have confronted it head-on...