Breast Cancer in Young Women: Poor Survival Despite Intensive Treatment

Abstract

BackgroundBreast cancer is uncommon in young women and correlates with a less favourable prognosis; still it is the most frequent cancer in women under 40, accounting for 30–40% of all incident female cancer. The aim of this study was to study prognosis in young women, quantifying how much stage at diagnosis and management on the one hand, and tumour biology on the other; each contribute to the worse prognosis seen in this age group.Methodology/Principal FindingsIn a registry based cohort of women aged 20–69 (n = 22 017) with a primary diagnosis of invasive breast cancer (1992–2005), women aged 20–34 (n = 471), 35–39 (n = 858) and 40–49 (n = 4789) were compared with women aged 50–69 years (n = 15 899). The cumulative 5-year relative survival ratio and the relative excess mortality (RER) were calculated. The cumulative 5-year relative survival ratio was lowest in women aged 20–34. The RER was 2.84 for women aged 20–34 and decreased with increasing age (RER 1.76 and 1.17 for women aged 35–39 and 40–49, respectively). The excess risk was, however, present only in disease stages I and II. For women aged 20–34 with stage I disease RER was 4.63, and 6.70 in the subgroup with tumour size 1–10 mm. The absolute difference in stage I between the youngest and the reference groups amounted to nearly 8%, with a 90% 5-year survival in women aged 20–34. In stages IIa and IIb, the relative excess risk was not as dramatic, but the absolute differences approached 15%. The youngest women with small tumours generally received more aggressive treatment than women in older age groups.ConclusionsAfter correction for stage, tumour characteristics and treatment, age remained an independent risk factor for breast cancer death in women <35 years of age. The excess risk for young women was only seen in early stages of disease and was most pronounced in women with small tumours. Young women affected by breast cancer have a high risk of dying compared to their middle-aged counterparts even if diagnosed early and receiving an intense treatment.

Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala

“…That the proportion ER-PR-was found to be higher, supports the hypothesis that breast cancer tends to be more aggressive in young individuals [15].…”

Comparison of primary and secondary breast cancers in adolescents and young adults

“…Young age is a known risk factor for decreased survival. [27][28][29] Black race is a known poor prognostic factor in young breast cancer patients, and lack of insurance has been shown to predict presentation at later cancer stages for AYAs. [30][31][32] In previous reports of subsequent breast cancers following a diagnosis of Hodgkin lymphoma, breast cancers were shown to more likely be hormone receptor negative and poorly differentiated.…”

“…Stage was classified based on the AJCC clinical and pathological staging systems for breast cancer. 21 Treatment variables included extent of surgery (no surgery, total or radical mastectomy [SEER codes , and less than total mastectomy, which includes nipple-sparing mastectomy [SEER codes [19][20][21][22][23][24][25][26][27][28][29][30]), any lymph nodes examined, and receipt of adjuvant therapy including chemotherapy, hormone, or immune therapy, or radiation (RT). 22 Last date of contact was used for the amount of follow-up time; those with 0 months or missing follow-up data were excluded from the survival analyses.…”

Oral Contraceptives, Abortion and Breast Cancer Risk: a Case Control Study in Saudi Arabia

“…Globally, about 1.4 million new cases are diagnosed each year. About 6.6% of all breast cancer cases are women less than 40 years of age, 2.4% less than 35, and 0.65% less than 30 (Anders et al, 2009;Fredholm et al, 2009). The increase in overall worldwide burden of breast cancer may be attributable to increasing life expectancy and widespread adoption of westernized lifestyle with its associated risk factors (Boyle and Howell, 2010).…”