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Tumor characteristics, therapy, and prognosis in young breast cancer patients ≤ 35 years

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purposes

Young breast cancer patients aged 35 years and younger are a small group of women who tend to present at high-risk form of the disease. More analysis of the data on tumor characteristics, treatment, and survival is necessary to help improving treatment and outcome.

Methods

In this retrospective study, we compared the clinical and tumor characteristics, the treatments, and the survival of 257 women aged ≤ 35 years, with 6566 women aged 50–69 years. We used a registry-based data of patients with invasive, non-metastatic breast cancer diagnosed between 2000 and 2015.

Results

Young women showed lower rate of hormone receptor (HR) positivity. Their tumors were more often HER2-positive, which showed lower rate of differentiation and higher rate of Ki-67 expression compared to their older counterparts. Women aged 35 years and younger were more likely to undergo neoadjuvant therapy and mastectomy. Endocrine therapy was underrepresented in young patients. 5-Year disease-free survival (DFS) was significantly lower in the younger patient group (81.7% vs. 91.3%, p < 0.001), while 5-year overall survival (OS) was not impaired (91.4% vs. 91.1%, p = 0.847).

Conclusion

The unfavorable disease-free survival in the group of younger patients might be explained by their unfavorable tumor characteristics. The surgical treatment appears to be more aggressive in young breast cancer patients and is more frequently combined with chemotherapy and immunotherapy, either in a neoadjuvant or in an adjuvant setting.

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Data availability

The data that support the findings of this study are available on request from the corresponding author EB. The data are not publicly available due to data protection according to German law.

References

  • Alieldin NH, Abo-Elazm OM, Bilal D, Salem SE, Gouda E, Elmongy M, Ibrahim AS (2014) Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis? J Egypt Natl Canc Inst 26:23–30. https://doi.org/10.1016/j.jnci.2013.08.005

    Article  PubMed  Google Scholar 

  • Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, Wang Y, Marcom PK, Marks JR, Febbo PG, Nevins JR, Potti A, Blackwell KL (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 26:3324–3330. https://doi.org/10.1200/JCO.2007.14.2471

    Article  PubMed  Google Scholar 

  • Anders CK, Johnson R, Litton J, Phillips M, Bleyer A (2009) Breast cancer before age 40 years. Semin Oncol 36:237–249. https://doi.org/10.1053/j.seminoncol.2009.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  • Bantema-Joppe EJ, de Munck L, Visser O, Willemse PHB, Langendijk JA, Siesling S, Maduro JH (2011) Early-stage young breast cancer patients: impact of local treatment on survival. Int J Radiat Oncol Biol Phys 81:e553–e559. https://doi.org/10.1016/j.ijrobp.2011.02.060

    Article  PubMed  Google Scholar 

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  • Cancello G, Maisonneuve P, Rotmensz N, Viale G, Mastropasqua MG, Pruneri G, Veronesi P, Torrisi R, Montagna E, Luini A, Intra M, Gentilini O, Ghisini R, Goldhirsch A, Colleoni M (2010) Prognosis and adjuvant treatment effects in selected breast cancer subtypes of very young women (<35 years) with operable breast cancer. Ann Oncol 21:1974–1981. https://doi.org/10.1093/annonc/mdq072

    Article  CAS  PubMed  Google Scholar 

  • Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G, Luini A, Veronesi P, Intra M, Orecchia R, Catalano G, Galimberti V, Nolé F, Martinelli G, Goldhirsch A (2002) Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol 13:273–279. https://doi.org/10.1093/annonc/mdf039

    Article  CAS  PubMed  Google Scholar 

  • Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress RI, Altman DG, Durcan L, Simmonds P, Lawrence G, Jones L, Bliss J, Eccles D (2013) Prospective observational study of breast cancer treatment outcomes for UK women aged 18–40 years at diagnosis: the POSH study. J Natl Cancer Inst 105:978–988. https://doi.org/10.1093/jnci/djt134

    Article  CAS  PubMed  Google Scholar 

  • Dieci MV, Orvieto E, Dominici M, Conte P, Guarneri V (2014) Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist 19:805–813. https://doi.org/10.1634/theoncologist.2014-0108

    Article  PubMed  PubMed Central  Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. The Lancet 378:771–784. https://doi.org/10.1016/S0140-6736(11)60993-8

    Article  CAS  Google Scholar 

  • Eggemann H, Ignatov T, Burger E, Kantelhardt EJ, Fettke F, Thomssen C, Costa SD, Ignatov A (2015) Moderate HER2 expression as a prognostic factor in hormone receptor positive breast cancer. Endocr Relat Cancer 22:725–733. https://doi.org/10.1530/ERC-15-0335

    Article  CAS  PubMed  Google Scholar 

  • Eisen A, Fletcher GG, Gandhi S, Mates M, Freedman OC, Dent SF, Trudeau ME (2015) Optimal systemic therapy for early breast cancer in women: a clinical practice guideline. Curr Oncol 22:S67-81. https://doi.org/10.3747/co.22.2320

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • European Medicines Agengy (2008) Herceptin - Procedural steps taken and scientific information after the authorisation

  • Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS ONE 4:e7695. https://doi.org/10.1371/journal.pone.0007695

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST (2000) Stage 0 to stage III breast cancer in young women11No competing interests declared. J Am Coll Surg 190:523–529. https://doi.org/10.1016/s1072-7515(00)00257-x

    Article  CAS  PubMed  Google Scholar 

  • Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA (2009) Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg 208:341–347. https://doi.org/10.1016/j.jamcollsurg.2008.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  • Golshan M, Martin WJ, Dowlatshahi K (2003) Sentinel lymph node biopsy lowers the rate of lymphedema when compared with standard axillary lymph node dissection. Am Surg 69:209–211

    Article  PubMed  Google Scholar 

  • Han W, Kang SY (2010) Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer. Breast Cancer Res Treat 119:193–200. https://doi.org/10.1007/s10549-009-0388-z

    Article  PubMed  Google Scholar 

  • Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai W-Y, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28:4120–4128. https://doi.org/10.1200/JCO.2009.25.9655

    Article  PubMed  PubMed Central  Google Scholar 

  • Houssami N, Macaskill P, von Minckwitz G, Marinovich ML, Mamounas E (2012) Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer 48:3342–3354. https://doi.org/10.1016/j.ejca.2012.05.023

    Article  CAS  PubMed  Google Scholar 

  • Huiart L, Bouhnik A-D, Rey D, Tarpin C, Cluze C, Bendiane MK, Viens P, Giorgi R (2012) Early discontinuation of tamoxifen intake in younger women with breast cancer: is it time to rethink the way it is prescribed? Eur J Cancer 48:1939–1946. https://doi.org/10.1016/j.ejca.2012.03.004

    Article  PubMed  Google Scholar 

  • Huober J, von Minckwitz G, Denkert C, Tesch H, Weiss E, Zahm DM, Belau A, Khandan F, Hauschild M, Thomssen C, Högel B, Darb-Esfahani S, Mehta K, Loibl S (2010) Effect of neoadjuvant anthracycline-taxane-based chemotherapy in different biological breast cancer phenotypes: overall results from the GeparTrio study. Breast Cancer Res Treat 124:133–140. https://doi.org/10.1007/s10549-010-1103-9

    Article  CAS  PubMed  Google Scholar 

  • Informationszentrum für Standards in der Onkologie (2004) Interdisziplinäre Leitlinie der Deutschen Krebsgesellschaft und der Interdisziplinäre Leitlinie der Deutschen Krebsgesellschaft und der beteiligten medizinisch-wissenschaftlichen Fachgesellschaften: Diagnostik, Therapie und Nachsorge des Mammakarzinoms der Frau - Eine nationale S3-Leitlinie

  • Informationszentrum für Standards in der Onkologie (2008) Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms, 1st edn. Zuckschwerdt, Germering/München

  • Kataoka A, Tokunaga E, Masuda N, Shien T, Kawabata K, Miyashita M (2014) Clinicopathological features of young patients (<35 years of age) with breast cancer in a Japanese Breast Cancer Society supported study. Breast Cancer 21:643–650. https://doi.org/10.1007/s12282-013-0466-2

    Article  PubMed  Google Scholar 

  • Kooperationsgemeinschaft Mammographie (2021) Jahresbericht Evaluation 2019: Deutsches Mammographie-Screening-Programm.

  • Kroman N, Holtveg H, Wohlfahrt J, Jensen M-B, Mouridsen HT, Blichert-Toft M, Melbye M (2004) Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer 100:688–693. https://doi.org/10.1002/cncr.20022

    Article  PubMed  Google Scholar 

  • Kuehn T, Bembenek A, Decker T, Munz DL, Sautter-Bihl M-L, Untch M, Wallwiener D (2005) A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance. Cancer 103:451–461. https://doi.org/10.1002/cncr.20786

    Article  PubMed  Google Scholar 

  • Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, Lebeau A, Liedtke C, von Minckwitz G, Nekljudova V, Schmatloch S, Schrenk P, Staebler A, Untch M (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 14:609–618. https://doi.org/10.1016/S1470-2045(13)70166-9

    Article  PubMed  Google Scholar 

  • Kwong A, Cheung P, Chan S, Lau S (2008) Breast cancer in Chinese women younger than age 40: are they different from their older counterparts? World J Surg 32:2554–2561. https://doi.org/10.1007/s00268-008-9589-6

    Article  PubMed  Google Scholar 

  • Leitlinienprogramm Onkologie der AWMF, Deutschen Krebsgesellschaft e.V. und Deutschen Krebshilfe e.V. (2012) Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms: Langversion 3.0, Aktualisierung 2012

  • Liedtke C, Rody A, Gluz O, Baumann K, Beyer D, Kohls E-B, Lausen K, Hanker L, Holtrich U, Becker S, Karn T (2015) The prognostic impact of age in different molecular subtypes of breast cancer. Breast Cancer Res Treat 152:667–673. https://doi.org/10.1007/s10549-015-3491-3

    Article  CAS  PubMed  Google Scholar 

  • Lyman GH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS, Edge SB, Galper S, Hayman JA, Kim TY, Perkins CL, Podoloff DA, Sivasubramaniam VH, Turner RR, Wahl R, Weaver DL, Wolff AC, Winer EP (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720. https://doi.org/10.1200/JCO.2005.08.001

    Article  PubMed  Google Scholar 

  • Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE (2017) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of clinical oncology clinical practice guideline update. J Clin Oncol 35:561–564. https://doi.org/10.1200/JCO.2016.71.0947

    Article  PubMed  Google Scholar 

  • Maggard MA, O’Connell JB, Lane KE, Liu JH, Etzioni DA, Ko CY (2003) Do young breast cancer patients have worse outcomes? J Surg Res 113:109–113. https://doi.org/10.1016/S0022-4804(03)00179-3

    Article  PubMed  Google Scholar 

  • Pagani O, Regan MM, Walley BA, Fleming GF, Colleoni M, Láng I, Gomez HL, Tondini C, Burstein HJ, Perez EA, Ciruelos E, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Pinotti G, Puglisi F, Crivellari D, Ruhstaller T, Winer EP, Rabaglio-Poretti M, Maibach R, Ruepp B, Giobbie-Hurder A, Price KN, Bernhard J, Luo W, Ribi K, Viale G, Coates AS, Gelber RD, Goldhirsch A, Francis PA (2014) Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med 371:107–118. https://doi.org/10.1056/NEJMoa1404037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso M-J, Dent RA, Gelmon K, Gentilini O, Harbeck N, Margulies A, Meirow D, Pruneri G, Senkus E, Spanic T, Sutliff M, Travado L, Peccatori F, Cardoso F (2017) ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast 35:203–217. https://doi.org/10.1016/j.breast.2017.07.017

    Article  PubMed  Google Scholar 

  • Park I, Kim J, Kim M, Bae SY, Lee SK, Kil WH, Lee JE, Nam SJ (2013) Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma. J Breast Cancer 16:417–425. https://doi.org/10.4048/jbc.2013.16.4.417

    Article  PubMed  PubMed Central  Google Scholar 

  • Partridge AH, Hughes ME, Warner ET, Ottesen RA, Wong Y-N, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Tamimi RM (2016) Subtype-dependent relationship between young age at diagnosis and breast cancer survival. J Clin Oncol 34:3308–3314. https://doi.org/10.1200/JCO.2015.65.8013

    Article  PubMed  Google Scholar 

  • Rapiti E, Fioretta G, Verkooijen HM, Vlastos G, Schäfer P, Sappino A-P, Kurtz J, Neyroud-Caspar I, Bouchardy C (2005) Survival of young and older breast cancer patients in Geneva from 1990 to 2001. Eur J Cancer 41:1446–1452. https://doi.org/10.1016/j.ejca.2005.02.029

    Article  PubMed  Google Scholar 

  • Robert Koch-Institut (2017) Krebs in Deutschland für 2013/2014

  • Sabiani L, Houvenaeghel G, Heinemann M, Reyal F, Classe JM, Cohen M, Garbay JR, Giard S, Charitansky H, Chopin N, Rouzier R, Daraï E, Coutant C, Azuar P, Gimbergues P, Villet R, Tunon de Lara C, Lambaudie E (2016) Breast cancer in young women: Pathologic features and molecular phenotype. Breast 29:109–116. https://doi.org/10.1016/j.breast.2016.07.007

    Article  PubMed  Google Scholar 

  • Sasanpour P, Sandoughdaran S, Mosavi-Jarrahi A, Malekzadeh M (2018) Predictors of Pathological Complete Response to Neoadjuvant Chemotherapy in Iranian Breast Cancer Patients. Asian Pac J Cancer Prev 19:2423–2427. https://doi.org/10.22034/APJCP.2018.19.9.2423

  • Sharma D, Singh G (2017) Breast cancer in young women: A retrospective study from tertiary care center of north India. South Asian J Cancer 6:51–53. https://doi.org/10.4103/2278-330X.208859

    Article  PubMed  PubMed Central  Google Scholar 

  • Soares EWS, Nagai HM, Bredt LC, da Cunha AD, Andrade RJ, Soares GVS (2014) Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients. World J Surg Oncol 12:67. https://doi.org/10.1186/1477-7819-12-67

    Article  PubMed  PubMed Central  Google Scholar 

  • Statistisches Bundesamt Todesursachen in Deutschland - Fachserie 12 Reihe 4 – 2015

  • Untch M, Konecny GE, Paepke S, von Minckwitz G (2014) Current and future role of neoadjuvant therapy for breast cancer. Breast 23:526–537. https://doi.org/10.1016/j.breast.2014.06.004

    Article  PubMed  Google Scholar 

  • Varga D, Koenig J, Kuhr K, Strunz K, Geyer V, Kurzeder C, Atassi Z, Blettner M, Kreienberg R, Woeckel A (2010) Comparison of early onset breast cancer patients to older premenopausal breast cancer patients. Arch Gynecol Obstet 282:427–432. https://doi.org/10.1007/s00404-009-1339-y

    Article  PubMed  Google Scholar 

  • Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, de Cicco C, de Lucia F, Gennari R (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553. https://doi.org/10.1056/NEJMoa012782

    Article  PubMed  Google Scholar 

  • Vila J, Gandini S, Gentilini O (2015) Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast 24:175–181. https://doi.org/10.1016/j.breast.2015.02.002

    Article  PubMed  Google Scholar 

  • Villarreal-Garza C, Mohar A, Bargallo-Rocha JE, Lasa-Gonsebatt F, Reynoso-Noverón N, Matus-Santos J, Cabrera P, Arce-Salinas C, Lara-Medina F, Alvarado-Miranda A, Ramírez-Ugalde MT, Soto-Perez-de-Celis E (2017) Molecular subtypes and prognosis in young Mexican women with breast cancer. Clin Breast Cancer 17:e95–e102. https://doi.org/10.1016/j.clbc.2016.11.007

    Article  CAS  PubMed  Google Scholar 

  • von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 370:1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X

    Article  Google Scholar 

  • Wang X-X, Jiang Y-Z, Liu X-Y, Li J-J, Song C-G, Shao Z-M (2016) Difference in characteristics and outcomes between medullary breast carcinoma and invasive ductal carcinoma: a population based study from SEER 18 database. Oncotarget 7:22665–22673. https://doi.org/10.18632/oncotarget.8142

  • Wang J, Wang J, Li Q, Zhang P, Yuan P, Ma F, Luo Y, Cai R, Fan Y, Chen S, Li Q, Xu B (2017) Young breast cancer patients who develop distant metastasis after surgery have better survival outcomes compared with elderly counterparts. Oncotarget 8:44851–44859. https://doi.org/10.18632/oncotarget.15268

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Author notes

  1. Naaja-Kristin Eckardt and Atanas Ignatov have equally contributed to this work.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany

    Naaja-Kristin Eckardt, Atanas Ignatov, Anne-Marie Meinecke, Serban-Dan Costa & Holm Eggemann

  2. Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany

    Atanas Ignatov

  3. Cancer Registry Magdeburg, Magdeburg, Germany

    Elke Burger

  4. Department of Gynecology and Obstetrics, Klinikum Magdeburg gGmbH, Mageburg, Germany

    Holm Eggemann

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  1. Naaja-Kristin Eckardt
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Eckardt, NK., Ignatov, A., Meinecke, AM. et al. Tumor characteristics, therapy, and prognosis in young breast cancer patients ≤ 35 years. J Cancer Res Clin Oncol 149, 709–719 (2023). https://doi.org/10.1007/s00432-022-04374-7

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