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Original Scientific Article
Stage 0 to Stage III Breast Cancer in Young Women
Csaba Gajdos, MD, Paul I Tartter, MD, FACS, Ira J Bleiweiss,
MD, Carol Bodian, PhD, Steven T Brower, MD, FACS
Background: Breast cancer survival is improving because
mammography is leading to diagnosis at earlier stages of the
disease. Because young women with breast cancer rarely undergo
mammography before diagnosis, outcomes for breast cancer in young
women may not be improving. In addition to advanced stage, young
age at diagnosis is associated with biologically more aggressive
cancers with higher rates of local and distant recurrence.
Study Design: Risk factors, clinical presentations,
pathologic findings, tumor characteristics, extent of disease,
treatment, and outcomes for 101 women under age 36 treated for
breast cancer between 1989 and 1997 were compared with 631 patients
36 years and older treated by us during the same interval. Stage
IV patients were excluded.
Results: Patients younger than 36 years were more likely
to present with a palpable mass (87% versus 55%, p<0.001)
and were less likely to undergo spot localization breast biopsy
for mammographic findings (40% versus 6%, p<0.001). Patients
younger than 36 years had larger tumors (median 2.0 cm versus
1.5 cm, p<0.001), more nodal involvement (50% versus 37%,
p=0.022), more nodes involved (median 1.0 versus 0, p=0.010),
and were more likely to be diagnosed with stage II or III cancer
(60% versus 43%, overall p<0.001). Young patients' cancers
were more poorly differentiated (80% versus 44%, overall p<0.001),
estrogen receptor-negative (52% versus 31%, p<0.001), aneuploid
(70% versus 49%, p=0.013), and had higher S-phase fractions (59%
versus 29%, p=0.001). Patients less than 36 years were treated
more often with mastectomy (59% versus 22%, p<0.001) and adjuvant
chemotherapy (80% versus 54%, p<0.001) and less often with
tamoxifen (36% versus 58%, p=0.001). Cumulative 5-year local
and distant disease-free survival were significantly worse for
patients younger than 36 years (p=0.011 and p=0.044, respectively).
The higher rate of local recurrence in patients less than 36
years was from an excess number of local recurrences in patients
treated with breast conservation. After consideration for nodal
involvement, chemotherapy, and tamoxifen using the Cox proportional
hazards model, no other variable, including age, was significantly
related to local disease-free outcomes. After consideration for
tumor size and nodal involvement, no other variable was significantly
related to distant disease failure rates.
Conclusions: Patients diagnosed with breast cancer
before age 36 differ from older patients in numerous respects.
They present more often with a palpable mass rather than a mammographic
finding and their cancers are more advanced with features that
are more aggressive. Despite aggressive treatment, most commonly
with mastectomy and chemotherapy, local and distant failure rates
are higher than for patients 36 and older. The higher rate of
local recurrence in patients less than 36 years reflects an excess
number of local recurrences in patients treated with breast conservation.
Introduction
| Methods
| Results
| Discussion
| References
Full
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JACS |
