Pathological profiles and clinical management challenges of breast cancer emerging in young women in Indonesia: a hospital-based study

Abstract

BackgroundBreast cancer diagnosed at a young age is often associated with aggressive biology, advanced stage, and unfavorable prognosis. The median age of breast cancer diagnosis in Indonesia is younger (48 vs. 68 years-old in Europe) with a relatively higher proportion of patients younger than 40 years old. Although prognosis and outcome of young breast cancer are well studied in developed nations, research evaluating biological characteristics, delivered treatment, and clinical outcomes is very limited in Indonesia.MethodsWe analyzed all breast cancer patients who underwent surgery at Dr. Sardjito Hospital, Indonesia, in 2012–2017. Details of pathology profiles, treatment administrated, and outcomes, as well as reproductive factors among patients younger than 40 years old, were collected and analyzed. Kaplan-Meier curve was used to assess conditional survival based on baseline characteristics.ResultsFrom the total of 1259 breast cancer patients (median age 51 years), 144 (11.4%) were younger than 40 years old (median age 37 years). Of these young patients, 19 (13.2%) were bilateral and 92 (64%) were diagnosed in advanced stages (stages IIIA-C and IV). Median tumor diameter was 5.5 cm and nodal infiltration was present in 73%. Distant metastasis was found in 16% at the time of diagnosis. Moderate and poor differentiation of tumor were 20.8 and 78.5%, respectively, and lymphovascular invasion was found in 90.3%. Around 40% were hormone receptor-positive, 30.6% human epidermal growth factor receptor 2 positive, and 38.2% triple negative. Patients underwent radical surgery in 121 cases (84%) and breast conserving surgery in 7 cases (4.9%). Adjuvant chemotherapy was administrated in 68% and hormonal therapy in 34%. Progression-free survival was significantly shorter in patients with advanced stage, skin and chest wall involvement (T4), positive lymph node infiltration, positive hormonal receptor, and triple negative subtype (log-rank Mantel-Cox tests, p < 0.05).ConclusionWe found a high frequency of young breast cancer with biologically more aggressive tumors, late diagnosis, frequent relapse, and poor prognosis. Further actions to improve clinical management and meet psychosocial needs in young breast cancer patients are warranted.

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

“…Demographic variables were distributed evenly among intrinsic breast cancer subtypes ( Table 1). Diagnosis of breast cancer in women younger than 40 years old correlated with a higher risk of metastasis (Table 3and 4) confirming our previous report of aggressive behavior in younger patients [27,28]. In relation to distant metastasis, younger age and late menopause were associated with increased risks and the odds ratio was higher in the luminal subtype for women younger than 40 years old and in TNBC for women with menopause older than 50 years old.…”

Dynamic Changes of Circulating Mir-155 Expression and the Potential Application as a Non-Invasive Biomarker in Breast Cancer

“…Larger study might be required to explore the potential use of circulating miR-155 as a prognostic marker in breast cancer with particular analysis depending on the subtypes, specific molecular characteristics, and tumor heterogeneity. Although breast cancer in younger women has been associated with more biologically aggressive behavior (Anwar et al, 2019a), we showed higher expression of circulating miR-155 in patients older than 40 years old. Expression of miR-155 interacts with hormonal receptor status and metabolic reprogramming in breast cancer (Bacci et al, 2016;Zeng et al, 2014).…”

Upregulation of Circulating MiR-21 Expression as a Potential Biomarker for Therapeutic Monitoring and Clinical Outcome in Breast Cancer

“…Other previous studies (Alunni-Fabbroni et al, 2018;Gao et al, 2013) also did not find an association of miR-21 expression with baseline stages and differentiation grades. We presented higher expression of circulating miR-21 in young breast cancer patients (less than 40-year-old) that are commonly associated with aggressive biology and poor prognosis (Anwar et al, 2019). Although further study is required, our finding might reflect that miR-21 upregulation is an important marker for diagnosis and therapeutic response.…”