Early-onset breast cancer – histopathological and prognostic considerations

Kollias, James; Elston, C. W.; Ellis, Ian O.; Robertson, John F.R.; Blamey, R.W.

doi:10.1038/bjc.1997.223

Cited by 186 publications

(145 citation statements)

References 25 publications

(30 reference statements)

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“…If these carcinomas had not been selected in this manner, a higher percentage of high-grade carcinomas would be expected in the premenopausal group and a lower percentage expected in the postmenopausal group. 27,28 In spite of this selection process, the younger, premenopausal group of carcinomas had a higher stage (greater than stage I; p ϭ 0.003), a greater incidence of positive lymph nodes (p ϭ 0.041) and larger tumors (p Ͻ 0.001). There was a higher percentage of Caucasian women (84%) than African American women (16%) who were premenopausal and Յ45 (p ϭ 0.012).…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

“…24,31,32 Thus, it has been speculated that the less favorable prognostic profile of breast carcinomas in younger women is a result of their higher histologic grade rather than the hormonal environment or other biologic differences. 28 Previous studies comparing breast carcinomas in older and younger women have not been specifically designed to control for the association of histologic grade with the expression of prognostic markers.To test the hypothesis that expression of ER and PR and indicators of cellular proliferation are more closely associated with menopausal status than histologic grade, we assessed the expression of ER, PR and p27 Kip1 (a cyclin-dependent kinase inhibitor that prevents the transition from G1 to S-phase of the cell cycle), the rate of cellular proliferation and survival in premenopausal women 45 years of age or younger (Յ45) and postmenopausal women 65 years of age and older (Ն65) after controlling for histologic grade and type of carcinoma. …”

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confidence: 99%

“…Also, comparisons of the pathology of breast carcinomas have demonstrated that there is a greater proportion of high-grade carcinomas in young women (younger than 40 years) 27,28 and that special histologic types of invasive carcinoma (e.g., mucinous and papillary carcinomas) with more favorable prognoses than the more common infiltrating ductal carcinoma are more prevalent in older than younger populations. 29,30 However, histologic grade and type are closely related to the presence of other prognostic markers, including ER, rate of cell proliferation and p53 status.…”

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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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Section: Characteristics Of the Study Populationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…2 Kollias et al estimated that approximately 1.1 women per 10,000 women between the ages of 26 and 35 would develop breast carcinoma. 3 This means that breast carcinoma is a very rare disease in women aged Ͻ 25 years, and as a consequence there are, to our knowledge, no studies that have reported outcome in breast carci-noma for women in this age group. In the U.K., the incidence of breast carcinoma in the 20 -24 year age group is 1.2 per 100,000 women, and between 15-19 years of age the rate is 0.3 per 100,000 women.…”

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Breast carcinoma in women age 25 years or less

Kothari

Beechey-Newman

D’Arrigo

et al. 2002

Cancer

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BACKGROUNDAlthough several studies have examined breast carcinoma in young women aged ≤ 35 years at diagnosis, there are only occasional cases reported in very young women aged ≤ 25 years, and, to the authors' knowledge, no series are available. The presentation, tumor biology, behavior, and outcome of breast carcinoma in very young women are not known, and the rarity of breast malignancy within this age group could lead to diagnostic delays.METHODSThe tumor characteristics and survival of 15 women aged ≤ 25 years at the time of diagnosis, have been reviewed and compared with women aged 26–35 years under the care of Guy's Hospital's Breast Unit during the same period of time. Where appropriate, the two groups were individually matched for tumor size (clinical measurement) and histologic grade.RESULTSFifteen cases were examined, with a median follow‐up of 108 months and a median age of 24 years. The median duration of symptoms was 4 weeks, and the median tumor size was 20 mm. Two patients had ductal carcinoma in situ (DCIS) only, while the other 13 patients had invasive carcinomas, none of which were Grade I. A mastectomy was performed on 8 out of 15 patients (53%). Axillary nodal metastases were present in 4 out of 12 patients (33%). Of the 13 cases of invasive disease, 9 out of 13 patients (69%) experienced recurrence and died of breast carcinoma. Median disease free survival for patients with invasive disease was 86 months. There was no difference in overall survival between the patients aged ≤ 25 years and those aged 26–35, but taken together young women ≤ 35 had a worse prognosis than women between 36 and 65, due to a higher incidence of high grade and estrogen receptor negative tumors.CONCLUSIONSThe current study suggests that among young women with breast carcinoma there is no difference in prognosis between the very young and the young. Despite two thirds of patients being node negative, the high mortality rate indicates a need for an optimal selection of adjuvant therapy among these cases. Cancer 2002;94:606–14. © 2002 American Cancer Society.DOI 10.1002/cncr.10273

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Breast Cancer

Fitzgibbons¹

2014

TNM Online

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Breast cancer is a heterogeneous disease that exhibits a wide variety of clinical presentations, histologic types, and growth rates. Because of these variations, determining prognosis for an individual patient at the time of initial diagnosis requires careful assessment of multiple clinical and pathological parameters. This evaluation includes consideration of an expanding list of tumor‐ and patient‐related prognostic factors, which are especially important for decisions related to systemic treatment and predictions for overall survival.

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Early-onset breast cancer – histopathological and prognostic considerations

Cited by 186 publications

References 25 publications

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

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

Breast carcinoma in women age 25 years or less

Breast Cancer

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