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Analysis of breast cancer in young women in the Department of Defense (DOD) database

  • Epidemiology
  • Published:
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Abstract

Purpose

Breast tumors from young women under the age of 40 account for approximately 7% of cases and have a poor prognosis independent of established prognostic factors. We evaluated the patient population served by the Military Health System, where a disproportionate number of breast cancer cases in young women are seen and treated in a single universal coverage healthcare system.

Methods

The Military Health System Repository and the DoD Central Registration databases were used to identify female breast cancer patients diagnosed or treated at military treatment facilities from 1998 to 2007.

Results

10,066 women were diagnosed with invasive breast cancer at DoD facilities from 1998 to 2007, of which 11.3% (1139), 23.4% (2355) and 65.2% (6572) were < 40, 40–49 and > 50 years old (yo), respectively, at diagnosis. 53% in the < 40 yo cohort were white, 25% were African American (AA) and 8% were Hispanic, with 14% undisclosed. Breast cancer in women diagnosed < 40 yo was more high grade (p < 0.0001), Stage II (p < 0.0001) and ER negative (p < 0.0001). There was a higher rate of bilateral mastectomies among the women < 40 compared to those 40–49 and > 50 (18.4% vs. 9.1% and 5.0%, respectively). Independent of disease stage, chemotherapy was given more frequently to < 40 yo (90.43%) and 40–49 yo (81.44%) than ≥ 50 yo (53.71%). The 10-year overall survival of younger women was similar to the ≥ 50 yo cohort. Outcomes in the African American and Hispanic subpopulations were comparable to the overall cohort.

Conclusion

Younger women had a similar overall survival rate to older women despite receiving more aggressive treatment.

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Abbreviations

< 40 yo:

Less than 40 years old

40–49 yo:

40–49 years old

≥50 yo:

50 and above

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Acknowledgements

This research was supported by the Intramural Research Program of the National Cancer Institute, Center for Cancer Research and by the Murtha Cancer Center at the Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences. The authors thank Defense Health Agency, Joint Pathology Center, ICF, and Division of Cancer Epidemiology and Genetics of the National Cancer Institute for their support for the original data linkage. The views expressed in this manuscript are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US. Government.

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Authors and Affiliations

  1. Women’s Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    Alexandra S. Zimmer, Patricia S. Steeg, Alex Wu, Margaret E. Gatti-Mays, Sanaz Soltani & Stanley Lipkowitz

  2. Division of Military Epidemiology and Population Sciences, Murtha Cancer Center, Uniformed Services University / Walter Reed NMMC, Bethesda, MD, USA

    Kangmin Zhu, Stephanie Shao, Derek Brown & Matthew Georg

  3. Murtha Cancer Center, Uniformed Services University / Walter Reed NMMC, Bethesda, MD, USA

    Jeremy G. Perkins & Craig D. Shriver

  4. Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA

    Hai Hu

  5. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Kangmin Zhu

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  1. Alexandra S. Zimmer
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Correspondence to Alexandra S. Zimmer.

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Zimmer, A.S., Zhu, K., Steeg, P.S. et al. Analysis of breast cancer in young women in the Department of Defense (DOD) database. Breast Cancer Res Treat 168, 501–511 (2018). https://doi.org/10.1007/s10549-017-4615-8

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  • DOI: https://doi.org/10.1007/s10549-017-4615-8

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