Tumour Biology and Survival Outcomes in Young Women with Breast Cancer: Single-centre Retrospective Analysis

Overview

Journal BJS Open

Publisher Oxford University Press

Specialty General Surgery

Date 2024 Dec 12

PMID 39665805

Authors

Patrick Pio Monaghan

Anne Shrestha

Emma Barrett

Mohammed Shamim Absar

Affiliations

Soon will be listed here.

Abstract

Introduction: Breast cancer is the most common malignancy worldwide. The disease is more severe in younger women and often confers a poorer prognosis. This study aimed to profile a cohort of young women with breast cancer and address whether aspects of their tumour biology were related to their long-term outcomes.

Methods: The records of consecutive women aged 40 and under with a diagnosis of breast cancer at a single centre between 1 January 2010 and 30 December 2015 were analysed and a profile was created. They were followed up until 19 July 2023 (median 112 months, range 4-161), and the impact of oestrogen positivity (ER+), human epidermal growth factor 2 positivity (HER2+), tumour grade, axillary lymph node metastases and Ki67 value on overall survival and disease-free interval (DFI) was investigated.

Results: One hundred and sixty-four patients were included. Younger patients typically presented with large, high-grade tumours with axillary lymph node metastases, and 83.2% of the cohort were alive at 5 years. ER+ tumours appeared to have a better 5-year survival: ER+/HER2- 86.3%, ER+/HER2+ 88.5%, ER-/HER2+ 71.4%, and triple-negative (ER-/HER2-) 70.8%. However, neither the log-rank test nor the Cox regression model found a significant effect of ER status and long-term survival (P = 0.485 and P = 0.158 respectively).

Discussion: Young patients with breast cancer have a lower 5-year survival than the UK average for all ages, and patients in this single-centre study with ER+ tumours appeared to have better short-term but similar longer-term outcomes compared to ER- breast cancer.

References

Rossi L, Mazzara C, Pagani O . Diagnosis and Treatment of Breast Cancer in Young Women. Curr Treat Options Oncol. 2019; 20(12):86. DOI: 10.1007/s11864-019-0685-7. View

Zhong W, Tan L, Jiang W, Chen K, You N, Sanders A . Effect of younger age on survival outcomes in T1N0M0 breast cancer: A propensity score matching analysis. J Surg Oncol. 2019; 119(8):1039-1046. DOI: 10.1002/jso.25457. View

Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H . Breast cancer in young women: poor survival despite intensive treatment. PLoS One. 2009; 4(11):e7695. PMC: 2770847. DOI: 10.1371/journal.pone.0007695. View

Kumar R, Abreu C, Toi M, Saini S, Casimiro S, Arora A . Oncobiology and treatment of breast cancer in young women. Cancer Metastasis Rev. 2022; 41(3):749-770. DOI: 10.1007/s10555-022-10034-6. View

Kong X, Liu Z, Cheng R, Sun L, Huang S, Fang Y . Variation in Breast Cancer Subtype Incidence and Distribution by Race/Ethnicity in the United States From 2010 to 2015. JAMA Netw Open. 2020; 3(10):e2020303. PMC: 7573683. DOI: 10.1001/jamanetworkopen.2020.20303. View

de Azambuja E, Cardoso F, de Castro Jr G, Colozza M, Mano M, Durbecq V . Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer. 2007; 96(10):1504-13. PMC: 2359936. DOI: 10.1038/sj.bjc.6603756. View

Zouzoulas D, Tsolakidis D, Gitas G, Zafrakas M, Goulis D, Douganiotis G . Breast cancer in women younger than 35 years old. Arch Gynecol Obstet. 2020; 302(3):721-730. DOI: 10.1007/s00404-020-05695-z. View

Narod S . Breast cancer in young women. Nat Rev Clin Oncol. 2012; 9(8):460-70. DOI: 10.1038/nrclinonc.2012.102. View

Corey B, Smania M, Spotts H, Andersen M . Young Women With Breast Cancer: Treatment, Care, and Nursing Implications. Clin J Oncol Nurs. 2020; 24(2):139-147. DOI: 10.1188/20.CJON.139-147. View

10.

Han W, Kim S, Park I, Kang D, Kim S, Youn Y . Young age: an independent risk factor for disease-free survival in women with operable breast cancer. BMC Cancer. 2004; 4:82. PMC: 545947. DOI: 10.1186/1471-2407-4-82. View

11.

Johansson A, Trewin C, Hjerkind K, Ellingjord-Dale M, Johannesen T, Ursin G . Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort. Int J Cancer. 2018; 144(6):1251-1261. DOI: 10.1002/ijc.31950. View

12.

Kushwaha A, Shin K, Kalambo M, Legha R, Gerlach K, Kapoor M . Overutilization of Health Care Resources for Breast Pain. AJR Am J Roentgenol. 2018; 211(1):217-223. DOI: 10.2214/AJR.17.18879. View

13.

Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G . Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol. 2002; 13(2):273-9. DOI: 10.1093/annonc/mdf039. View

14.

Ruddy K, Gelber S, Tamimi R, Schapira L, Come S, Meyer M . Breast cancer presentation and diagnostic delays in young women. Cancer. 2013; 120(1):20-5. DOI: 10.1002/cncr.28287. View

15.

Cook N, Batt J, Fowler C . Symptomatic Breast Cancers and Why Breast Pain May not Always Need Clinical Review. Eur J Breast Health. 2020; 16(4):267-269. PMC: 7535992. DOI: 10.5152/ejbh.2020.5730. View

16.

Partridge A, Hughes M, Ottesen R, Wong Y, Edge S, Theriault R . The effect of age on delay in diagnosis and stage of breast cancer. Oncologist. 2012; 17(6):775-82. PMC: 3380876. DOI: 10.1634/theoncologist.2011-0469. View

17.

Kim H, Han W, Yi O, Shin H, Ahn S, Koh B . Young age is associated with ipsilateral breast tumor recurrence after breast conserving surgery and radiation therapy in patients with HER2-positive/ER-negative subtype. Breast Cancer Res Treat. 2011; 130(2):499-505. DOI: 10.1007/s10549-011-1736-3. View

18.

Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress R . Prospective observational study of breast cancer treatment outcomes for UK women aged 18-40 years at diagnosis: the POSH study. J Natl Cancer Inst. 2013; 105(13):978-88. DOI: 10.1093/jnci/djt134. View

19.

Szollar A, Ujhelyi M, Polgar C, Olah E, Pukancsik D, Rubovszky G . A long-term retrospective comparative study of the oncological outcomes of 598 very young (≤35 years) and young (36-45 years) breast cancer patients. Eur J Surg Oncol. 2019; 45(11):2009-2015. DOI: 10.1016/j.ejso.2019.06.007. View

20.

Yang Y, Wei W, Jin L, He H, Wei M, Shen S . Comparison of the Characteristics and Prognosis Between Very Young Women and Older Women With Breast Cancer: A Multi-Institutional Report From China. Front Oncol. 2022; 12:783487. PMC: 8907474. DOI: 10.3389/fonc.2022.783487. View