Age and molecular subtypes: Impact on surgical decisions

Pilewskie, Melissa; King, Tari A.

doi:10.1002/jso.23604

Cited by 13 publications

(10 citation statements)

References 57 publications

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“…On the other hand, the association of age with HER2 overexpression was evident among both groups in this study and most significant in the British series (p<0.0001). That was illustrated by a sharp rise in the rate of that biomarker in younger women under 50 years; thus supporting prior studies which documented that young patients frequently present with HER2 overexpression when compared to their older counterparts [45]. A recent survey showed that HER2 positive frequencies increased when the patients were diagnosed at yes stages, with larger tumors, poorly differentiated grades, estrogen receptor-negative disease and younger ages (46).…”

Section: Discussionsupporting

confidence: 80%

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

Alwan¹,

Kerr²,

Al-Okati³

et al. 2018

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Background:Breast cancer is the most common cancer in Iraq and the United Kingdom. While the disease is frequently diagnosed among middleaged Iraqi women at advanced stages accounting for the second cause of cancer-related deaths, breast cancer often affects elderly British women yielding the highest survival of all registered malignancies in the UK. Objective:To compare the clinical and pathological profiles of breast cancer among Iraqi and British women; correlating age at diagnosis with the tumor characteristics, receptor-defined biomarkers and phenotype patterns. Methods:This comparative retrospective study included the clinical and pathological characteristics of (1,940) consecutive female patients who were diagnosed with invasive breast cancer from 2014 to 2016 in Iraq (Medical City Teaching Hospital, Baghdad: 635 cases) and UK (John Radcliffe, Oxford and Queen's, BHR University Hospitals: 1,305 cases). The studied parameters in both groups comprised the age of the patient at the time of diagnosis, breast cancer histologic type, grade, tumor size, lymph node status, clinical stage at presentation, Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2 positive tumor contents and the receptordefined breast cancer surrogate subtypes. Results:The Iraqi patients were significantly younger than their British counterparts and exhibited higher trend to present at advanced stages; reflected by larger size tumors and frequent lymph node involvement compared to the British (p<0.00001). They also had worse receptor-defined breast cancer subtypes manifested by higher rates of hormone receptor (ER/PR) negative, HER2 positive tumor contents, Triple Positive and Triple Negative phenotypes (p<0.00001). Excluding HER2 status, the significant differences in the clinical and tumor characteristics between the two populations persisted after adjusting for age among patients younger than 50 years. Conclusion:The remarkable differences in the clinical and tumor characteristics of breast cancer between the Iraqi and British patients suggest heterogeneity in the underlying biology of the tumor which is exacerbated in Iraq by the dilemma of delayed diagnosis. The significant ethnic disparities in breast cancer profiles recommend the prompt strengthening of the national cancer control plan in Iraq as a principal approach to the management of the disease. This comparative retrospective descriptive study included the clinical and pathological characteristics of (1,940) female patients diagnosed with invasive breast cancer in two countries; Iraq (635 cases) and UK (1,305 cases). The Iraqi GroupThis group enrolled 635 consecutive female patients who were diagnosed with breast cancer at the Referral Training Center for Early Detection of Breast Tumors, Medical City Teaching Hospital in Baghdad over a three-year period from 2014 to 2016. Data was extracted from an established information system database developed by the principal investigator under the direct supervision of the International Agency for Research on Cancer (IARC); utili...

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Section: Discussionsupporting

confidence: 80%

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

Alwan¹,

Kerr²,

Al-Okati³

et al. 2018

TOPHJ

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“…Young age at diagnosis is also associated with an unfavorable prognosis 8 . Data assessing differences in age-dependent prognosis in TNBC patients are limited and have yielded conflicting results 9,10 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Local and Distant Recurrence Patterns in Patients with Triple-Negative Breast Cancer According to Age

et al. 2016

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Background Triple-negative subtype (TNBC) and young patient age are both associated with an increased risk of local recurrence (LR) and distant recurrence (DR). In young women with TNBC, it is unclear whether subtype or patient age is driving prognosis. Methods Patients treated for primary TNBC from 1998 to 2011 were identified from the breast surgery database. Clinico-pathological characteristics, treatment, and outcomes were compared between patients < 40 and ≥ 40 years of age at diagnosis. Multivariate models were used to identify factors independently associated with LR and DR. Results Among 1930 patients with TNBC, 289 (15%) were < 40 and 1641 (85%) were ≥ 40 years of age at diagnosis. Younger patients were more likely to present with higher stage disease and more likely to receive mastectomy (p<0.01), axillary node dissection (p<0.01) and chemotherapy (p<0.01). At a median follow-up of 74 months (0-201.1) there was no difference in LR or disease-free survival (DFS) by age group (5 yr LR = 3.9% (95% CI 1.5-6.2) vs 4.5% (95% CI 3.5-5.6) and 5yr DFS = 75.3% (95% CI 70.2-80.7) vs. 77.7% (95% CI 75.6-79.8), p=0.94) in patients < 40 and ≥ 40 years respectively. On multivariate analysis, larger tumor size, lymphovascular invasion, and nodal positivity were associated with increased risk of DR. Age and type of surgery were not significantly associated with either outcome. Conclusion Young age at diagnosis is not an independent risk factor for LR or DR in patients with TNBC.

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“… 13 Although randomized controlled trials (RCTs) suggest equivalent survival for mastectomy and BCS, very few young patients were included in these analyses. 6 , 14 Indeed, young women are not routinely analyzed or reported separately in individual RCTs of BCS versus mastectomy, and any that do have very few women ≤40 years presented. 12 …”

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confidence: 99%

Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer

et al. 2017

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Age and molecular subtypes: Impact on surgical decisions

Cited by 13 publications

References 57 publications

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

Evaluation of Local and Distant Recurrence Patterns in Patients with Triple-Negative Breast Cancer According to Age

Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer

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