Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India

Abstract

Background: Young (40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. Methods: The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. Results: There were 1228 patients with a median age of 36 (12e40) years; 38 (3.1%) had Stage I, 455 (37.1%) -II, 692 (56.3%) eIII, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0e131) months, 5-year overall and disease-free survival was 79.6% (76.8e82.5) and 59.1% (55.8e62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8e90.6), 77.3% (73.4e81.2), 69.7% (52.5e86.9) and disease-free survival was 94% (85.9e100), 65.9% (60.3e71.5), 55% (50.5e59.5), and 29.6% (14e45.2) respectively. On multivariate analysis, TNBC and HER-2þ subgroups had poorer survival (p ¼ 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6e86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. Conclusion: More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.

What Is Known about Breast Cancer in Young Women?

“…Women aged <40 years were 44% (HR = 1.44; 95% CI: 1.27–1.64) and 9% (HR = 1.09; 95% CI: 1.03–1.15) more likely to die of stage I and stage II breast cancer, respectively [ 204 ]. Further, a significantly lower overall survival (OS) and disease-free survival (DFS) have been reported in Mexican, Hungarian, and Indian cohorts in very young (<35 years of age) women compared to young (<45 years), which may be related to the more aggressive subtypes of tumours developing in earlier ages [ 205 , 206 , 207 ]. Bajpai et al conducted a prospective cohort study enrolling 1228 women aged ≤40 years.…”

Postmastectomy Breast Reconstruction: An Exigent Need for the Impetus

“…Further, the young women with breast cancer under 40 constitute ∼17%, with challenges of aggressive disease and associated psychosocial and economic issues. 4 In a study from Tata Memorial Hospital of young women with a median age of 36 years, only ∼10% underwent reconstruction following mastectomy, all with microsurgical flaps. 4 Despite these women in the most eligible age group in a dedicated tertiary cancer hospital with a multidisciplinary team, the percentage of reconstructions remains low.…”

“… 4 In a study from Tata Memorial Hospital of young women with a median age of 36 years, only ∼10% underwent reconstruction following mastectomy, all with microsurgical flaps. 4 Despite these women in the most eligible age group in a dedicated tertiary cancer hospital with a multidisciplinary team, the percentage of reconstructions remains low. The reasons mentioned were “patient's reluctance, irrational fears of delay in treatment, additional cost, and other logistic issues.” It is pertinent to evaluate all such factors closely and rectify them.…”

Delineation of Pathogenomic Insights of Breast Cancer in Young Women

“…However, the current trend of a high incidence of aggressive BC in women aged ≤40 or ≤35 years argues against the validity of growing age as a risk factor for BCYW. The prevalence of BCYW is approximately 2–6% in Western countries and 10–20% in Asian countries [ 6 ], suggesting that BCYW has become a growing concern globally, including in countries with a vast young population such as India.…”

“…BCYW exhibits more aggressive cancer subtypes (such as TNBC/basal, HER2-positive, and luminal B) than BC in older patients [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The prognosis of BCYW is generally worse than that of BC in older patients, presumably due to its aggressive subtypes, detection at an advanced stage, and a high recurrence rate [ 1 , 6 , 15 , 16 , 17 , 18 , 19 ]. The occurrence of breast cancer early in life also translates into many social, economic, psychologic, and medical issues, including a relatively early disease relapse as compared to breast cancer in older age groups, even after a long tumor dormancy.…”