Age Does Not Predict Breast Cancer Outcome

Crowe, Joseph P.; Gordon, Nahida H.; Shenk, Robert; Zollinger, Robert M.; Brumberg, Dorothy J.; Shuck, Jerry M.

doi:10.1001/archsurg.1994.01420290029004

Cited by 52 publications

(28 citation statements)

References 23 publications

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“…This decision was intended to avoid well-known problems with the optimal cutpoints approach . Our estimated FP function seems to explain the current discussion about several cutpoints for young age which range at least from 33 (Rochefordiere et al, 1993) to 45 (Crowe et al, 1994;Collett et al, 1996). Moreover, our results give some indication that the effect of age is sometimes not established because of differences in statistical approaches.…”

Section: Discussionsupporting

confidence: 71%

Modelling the effects of standard prognostic factors in node-positive breast cancer

et al. 1999

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Summary Prognostic models that predict the clinical course of a breast cancer patient are important in oncology. We propose an approach to constructing such models based on fractional polynomials in which useful transformations of the continuous factors are determined. The idea may be applied with all types of regression model, including Cox regression, the method of choice for survival-time data. We analyse a prospective study of node-positive breast cancer. Seven standard prognostic factors -age, menopausal status, tumour size, tumour grade, number of positive lymph nodes, progesterone and oestrogen receptor concentrations -were investigated in 686 patients, of whom 299 had an event for recurrence-free survival and 171 died. We determine a final model with transformations of prognostic factors and compare it with the more traditional approaches using categorized variables or assuming a straight line relationship. We conclude that analysis using fractional polynomials can extract important prognostic information which the traditional approaches may miss.

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Section: Discussionsupporting

confidence: 71%

Modelling the effects of standard prognostic factors in node-positive breast cancer

et al. 1999

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“…These results are similar to those in previous studies in which cases were not selected to control for histologic grade or type. 3,8,12,49 Although the premenopausal women in our study presented with a higher stage of disease, overall survival in the pre-and postmenopausal women was similar. When comparing overall survival in women with high-and low-grade carcinomas, those with highgrade carcinomas had a worse prognosis, but, unexpectedly, this difference was largely a result of the particularly poor outcome of premenopausal women with high-grade carcinomas.…”

Section: Hormone Receptors and Breast Cancer Proliferationmentioning

confidence: 55%

Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre‐ and postmenopausal women

Talley

Grizzle

Waterbor

et al. 2001

Intl Journal of Cancer

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Breast cancers in younger, premenopausal women are more likely to exhibit an adverse prognostic profile (including negative steroid hormone receptors and a high rate of cellular proliferation) and poor outcome than breast cancers in postmenopausal women. It has been hypothesized that this adverse prognostic profile is a result of the higher histologic grade of breast cancers in pre-compared with post-menopausal women. To assess the association of expression of steroid hormone receptors and indicators of proliferation while controlling for histologic grade, we identified 100 infiltrating ductal carcinomas from premenopausal women 45 years of age or younger and 100 from postmenopausal women 65 years of age or older. The carcinomas were selected so that the histologic grades (low versus high) were distributed equally between the 2 groups. Estrogen receptors (ER), progesterone receptors (PR), p27 Kip1 and Ki-67 (to measure rate of proliferation) were assessed by immunohistochemistry and compared between groups. Clinical information and survival data were also analyzed. ER content was lower and proliferation was higher in carcinomas in premenopausal women (p ‫؍‬ 0.048 and p ‫؍‬ 0.005, respectively). By univariate analysis, p27 Kip1 and PR were not different between the groups; however, in multivariate analysis, p27 Kip1 was higher in postmenopausal women, but only in a subgroup with highly proliferative carcinomas. Overall survival was similar in the pre-and postmenopausal women. Furthermore, low p27 Kip1 and African-American ethnicity predicted a poorer overall survival in the premenopausal, but not in the postmenopausal, women in our study. After controlling for histologic grade, a lower expression of ER and a higher proliferative index were detected in breast carcinomas in premenopausal women. Therefore, some prognostic indicators, such as ER and proliferative rate, may be more closely associated with menopausal status than histologic grade. Our data also suggest that some prognostic factors are not equally effective as predictors of survival in pre-and postmenopausal women. Prognosis in women with breast cancer has been reported to differ according to age and menopausal status. Studies examining this issue have varied in design, age categorization and outcome measures. A few large population-based studies and more limited analyses 1-5 have indicated that women under the ages of 30 -40 years have a worse prognosis. Some retrospective studies have attempted to explain the less favorable outcome in younger women and have reported that breast cancers in younger women exhibit more adverse characteristics, including a high clinical stage at diagnosis, high histologic grade, lack of steroid hormone receptors and increased proliferation. 6 -9 Multivariate analyses to assess associations of age and menopausal status with other clinical and pathologic characteristics have not consistently retained either variable as an independent adverse prognosticator, 8 although several multivariate analyses have indicated that young ag...

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“…Other studies (29,30) have demonstrated that after controlling for stage, prognosis is unchanged regardless of age at diagnosis. Still other studies have demonstrated that while prognosis may be more closely related to stage at diagnosis than to age at diagnosis, younger women are more likely to present with advanced stage tumors than older women (31), and that the primary tumors of younger women are more likely to be associated with poor prognostic features, such as hormone receptor negativity, mitotic activity, and oncogene overexpression (10,15). Adding further confusion to these issues is the fact that there is no uniform definition for "early onset" breast cancer, with different studies using ages ranging from 30 to 50 years as cutoff points.…”

Section: Subsetmentioning

confidence: 99%

Age-related differences in breast cancer stage at diagnosis between black and white patients in an urban community hospital

Newman

Alfonso

1997

Annals of Surgical Oncology

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Age Does Not Predict Breast Cancer Outcome

Cited by 52 publications

References 23 publications

Modelling the effects of standard prognostic factors in node-positive breast cancer

Modelling the effects of standard prognostic factors in node-positive breast cancer

Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre‐ and postmenopausal women

Age-related differences in breast cancer stage at diagnosis between black and white patients in an urban community hospital

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