Where youth matters—clinicopathologic characteristics and emerging trends in treatment and outcomes in young Irish women with breast cancer
Young women with breast cancer (YWBC) represent 7–12% of breast cancer diagnoses and ostensibly have more biologically aggressive subtypes with higher relapse and mortality rates. We studied the clinical and pathological characteristics in YWBC and examined how outcomes and treatment have evolved.
YWBC were identified from pathology databases at two tertiary centers. Patients were divided into two cohorts: those diagnosed from 2000 to 2005 (C1) and from 2006 to 2015 (C2). Data were retrieved from clinical, radiology, and histology databases. Statistical analysis was performed using R® (V3.2.0).
We identified 345 patients. Median age was 36 years (23–39 years). Mastectomy was performed in 232 patients (67.2%) and axillary lymph node clearance (ALNC) in 207 patients (60% [C1 82.7 vs. C2: 49.4%, p < 0.001]). One hundred-seventy patients (49%) were ER + HER2−, 88 (25.5%) were HER2+, and 58 (16.8%) were triple negative. Eighty patients (23.2%) received neoadjuvant therapy. Pathological complete response rates were statistically similar between C1 and C2 [C1 1 (0.9%) vs C2 16 (6.8%) p = 0.1]. Distant relapse occurred in 59 (19%) patients. There was a higher relapse rate (RR) in C1 [27 (32.1%) vs. 32 (15.7%), p < 0.002). HER2+ and ER+ HER2− patients in C1 had higher RRs than C2. Median overall survival in patients with metastatic disease was 29 months (range 2–119 months).
Locally advanced disease was more prevalent in YWBC. Mastectomy and ALNC rates were high and most received multimodal treatment. The extent of axillary surgery declined over time. Outcomes were unchanged in triple negative patients. These remain a priority for research.
KeywordsAxillary lymph node clearance Breast cancer Chemotherapy Endocrine therapy Locally advanced Mastectomy Triple negative Young women
Compliance with ethical standards
Conflict of interest
Dr. Janice M. Walshe has served as consultant in an advisory role to Roche, Genomic Health, Pfizer. Dr. Giuseppe Gullo has served as a consultant in an advisory role to Roche, Novartis, BMS.
There are no other potential conflicts of interest.
- 1.Hankey BF, Miller B, Curtis R et al (1994) Trends in breast cancer in younger women in contrast to older women. J Natl Cancer Inst 16:7–14Google Scholar
- 2.Ries LAG, Eisner MP, Kosary C, et al. (2005) SEER Cancer Statistics Review, 1975–2002, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2002/, based on November 2004 SEER data submission, posted to the SEER web site 2005
- 6.Maggard MA, O'Connell JB, Lane KE, Liu JH, Etzioni DA, Ko CY (2003) Do young breast cancer patients have worse outcomes? J Surg Res 113(1):109–113Google Scholar
- 8.Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA (2009) Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg 208(3):341–337. https://doi.org/10.1016/j.jamcollsurg.2008.12.001 Google Scholar
- 9.de la Rochefordiere A, Asselain B, Campana F et al (1993) Age as prognostic factor in premenopausal breast carcinoma. Lancet 341(8852):1039–1043Google Scholar
- 10.Bonnier P, Romain S, Charpin C, Lejeune C, Tubiana N, Martin PM, Piana L (1995) Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer 62(2):138–144Google Scholar
- 17.Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, Brachtel EF, Schapira L, Come SE, Winer EP, Partridge AH (2012) Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat 131(3):1061–1066. https://doi.org/10.1007/s10549-011-1872-9 Google Scholar
- 21.Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL, Geradts J, Cheang MCU, Nielsen TO, Moorman PG, Earp HS, Millikan RC (2006) Race, breast cancer subtypes, and survival in the Caroline breast cancer study. JAMA 295(21):2492–2502Google Scholar
- 22.Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress RI, Altman DG, Durcan L, Simmonds P, Lawrence G, Jones L, Bliss J, Eccles D, POSH Study Steering Group (2013) Prospective observational study of breast cancer treatment outcomes for UK women aged 18-40 years at diagnosis: the POSH study. J Natl Cancer Inst 105(13):978–988. https://doi.org/10.1093/jnci/djt134 Google Scholar
- 24.Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
- 25.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717Google Scholar
- 26.Rakha EA, Putti TC, Abd El-Rehim DM et al (2006) Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentiation. J Pathol 208(4):495–506Google Scholar
- 27.Louwman MW, Vriezen M, van Beek MW et al (2007) Uncommon breast tumors in perspective: incidence, treatment and survival in the Netherlands. Int J Cancer 121(1):127–135Google Scholar
- 31.Han W, Kang SY, Korean Breast Cancer Society (2010) Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer. Breast Cancer Res Treat 119(1):193–200. https://doi.org/10.1007/s10549-009-0388-z Google Scholar
- 33.Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Morrow M (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA 318(10):918–926. https://doi.org/10.1001/jama/2017/11470 Google Scholar
- 34.Kroman N, Holtveg H, Wohlfahrt J, Jensen MB, Mouridsen HT, Blichert-Toft M, Melbye M (2004) Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer 100(4):688–693Google Scholar
- 35.Mahmood U, Morris C, Neuner G, Koshy M, Kesmodel S, Buras R, Chumsri S, Bao T, Tkaczuk K, Feigenberg S (2012) Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer. Int J Radiat Oncol Biol Phys 83(5):1387–1393. https://doi.org/10.1016/j.ijrobp.2011.10.075 Google Scholar
- 39.Kroman N, Jensen MB, Wohlfahrt J et al (2003) Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 320(7233):474–478Google Scholar
- 40.Gnant M, Mlineritsch B, Stoeger H (2015) Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozole plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian breast and colorectal cancer study group trial 12. Ann Oncol 26(2):313–320. https://doi.org/10.1093/annonc/mdu544 Google Scholar
- 41.Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, Hiller W, Fisher ER, Wickerham DL, Bryant J, Wolmark N (2004) A multigene assay to predict recurrence of tamoxifen-treated, node negative breast cancer. N Engl J Med 351(27):2817–2826Google Scholar