World Journal of Surgery

, 32:2554

Breast Cancer in Chinese Women Younger than Age 40: Are They Different from Their Older Counterparts?

  • Ava Kwong
  • Polly Cheung
  • Stephanie Chan
  • Silvia Lau



Breast cancer in young women is uncommon, but when it does occur it has been reported to have aggressive biological characteristics. The incidence of breast cancer peaks at age 40 in Hong Kong Chinese women, earlier than in Caucasians. This study is the first to report the tumor characteristics and management of breast cancer in Chinese women younger than age 40 and a comparison with their older counterparts.

Materials and methods

Demographic and clinicopathologic findings of 1,485 Chinese women with breast cancer seen during the period September 2003 to November 2006 were prospectively recorded, and comparisons were made between those who were under the age of 40 and those 40 years of age and older. These results were then compared with a reference population obtained from the Surveillance, Epidemiology and End Results (SEER) database between 2003 and 2004.


17.6% of the women were younger than 40 years old, and age distribution was significantly different from women in the SEER database. The mean age at menarche was lower in women under age 40 (p < 0.0005), and age at first live birth was also higher (p = 0.017). The rate of first detection by screening mammography was significantly higher among women who were 40 of age and older (p = 0.002). Breast conservation surgery was more commonly performed in the younger age group of Chinese women, particularly when tumor size was less than 2 cm (p = 0.001). A significantly higher proportion of women under age 40 had breast reconstruction (p < 0.001). The majority of women presented with stage 0-II disease, but in the Chinese groups the younger patients presented at a later stage (p = 0.04). Younger women had higher pathological grade and poorly differentiated tumors (p = 0.02), more nodal involvement (p = 0.024), and lymphovascular permeation involvement (p < 0.001). The majority of tumors were ER and PR positive in both groups, but younger women had a higher proportion of cerbB2-positive tumors.


Chinese women present with breast cancer at an earlier age. Younger women present with more advanced disease and more aggressive tumor characteristics. More ethnic-specific screening protocols and treatment decisions may benefit this group of patients.


  1. 1.
    Shaw de Paredes E, Marsteller LP, Eden BV (1990) Breast cancers in women 35 years of age and younger: mammographic findings. Radiology 177:117–119Google Scholar
  2. 2.
    Hankey BF, Miller B, Curtis R, et al (1994) Trends in breast cancer in younger women in contrast to older women. J Natl Cancer Inst Monogr 16:7–14PubMedGoogle Scholar
  3. 3.
    Lee CG, McCormick B, Mazumdar M et al (1992) Infiltrating breast carcinoma in patients age 30 years and younger: long term outcome for life, relapse, and second primary tumors. Int J Radiat Oncol Biol Phys 23:969–975PubMedGoogle Scholar
  4. 4.
    Calle EE, Martin LM, Thun MJ et al (1993) Family history, age, and risk of fatal breast cancer. Am J Epidemiol 138:675–681PubMedGoogle Scholar
  5. 5.
    de la Rochefordiere A, Asselain B, Campana F et al (1993) Age as prognostic factor in premenopausal breast carcinoma. Lancet 341:1039–1043CrossRefGoogle Scholar
  6. 6.
    Thurfjell E, Hsieh CC, Lipworth L et al (1996) Breast size and mammographic pattern in relation to breast cancer risk. Eur J Cancer Prev 5:37–41PubMedCrossRefGoogle Scholar
  7. 7.
    Host H, Lund E (1986) Age as a prognostic factor in breast cancer. Cancer 57:2217–2221PubMedCrossRefGoogle Scholar
  8. 8.
    Kleinfeld G, Haagensen CD, Cooley E (1963) Age and menstrual status as prognostic factors in carcinoma of the breast. Ann Surg 157:600–605PubMedCrossRefGoogle Scholar
  9. 9.
    Nixon AJ, Neuberg D, Hayes DF et al (1994) Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 12:888–894PubMedGoogle Scholar
  10. 10.
    Rosen PP, Lesser ML, Kinne DW et al (1984) Breast carcinoma in women 35 years of age or younger. Ann Surg 199:133–142PubMedCrossRefGoogle Scholar
  11. 11.
    Schmidt RT, Tsangaris TN, Cheek JH (1991) Breast cancer in women under 35 years of age. Am J Surg 162:197–201PubMedCrossRefGoogle Scholar
  12. 12.
    Yildirim E, Dalgic T, Berberoglu U (2000) Prognostic significance of young age in breast cancer. J Surg Oncol 74:267–272PubMedCrossRefGoogle Scholar
  13. 13.
    Hong Kong Cancer Registry (2004) Cancer Registry Annual Report. Hong Kong Hospital AuthorityGoogle Scholar
  14. 14.
    Fleming ID (2001) AJCC/TNM cancer staging, present and future. J Surg Oncol 77:233–226PubMedCrossRefGoogle Scholar
  15. 15.
    Bloom HJ, Richardson WW (1957) Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer 11:359–377PubMedGoogle Scholar
  16. 16.
    Cancer Incidence in Five Continents (2000) Volume VIII, Lyons, France. IARC Sci Publ 155:1–781Google Scholar
  17. 17.
    Swanson GM, Lin CS (1994) Survival patterns among younger women with breast cancer: the effects of age, race, stage, and treatment. J Natl Cancer Inst Monogr 16:69–77PubMedGoogle Scholar
  18. 18.
    Liede A, Narod SA (2002) Hereditary breast and ovarian cancer in Asia: genetic epidemiology of BRCA1 and BRCA2. Hum Mutat 20:413–424PubMedCrossRefGoogle Scholar
  19. 19.
    Robson M (2004) Breast cancer surveillance in women with hereditary risk due to BRCA1 or BRCA2 mutations. Clin Breast Cancer 5:260–268; discussion 269–271PubMedCrossRefGoogle Scholar
  20. 20.
    Juon HS, Choi Y, Kim MT (2000) Cancer screening behaviors among Korean-American women. Cancer Detect Prev 24:589–601PubMedGoogle Scholar
  21. 21.
    Kwong A, Cheung PSY, Wong AW et al (2007) The acceptance and feasibility of breast cancer screening in the East. Breast 17:42–50PubMedCrossRefGoogle Scholar
  22. 22.
    Foxcroft LM, Evans EB, Porter AJ (2004) The diagnosis of breast cancer in women younger than 40. Breast 13:297–306PubMedCrossRefGoogle Scholar
  23. 23.
    Kerlikowske K, Grady D, Barclay J et al (1996) Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA 276:33–38PubMedCrossRefGoogle Scholar
  24. 24.
    Maskarinec G, Meng L, Shimozuma K (1999) A pilot study of mammographic density patterns among Japanese women. J Epidemiol 9:73–77PubMedGoogle Scholar
  25. 25.
    del Carmen MG, Halpern EF, Kopans DB et al (2007) Mammographic breast density and race. AJR Am J Roentgenol 188:1147–1150PubMedCrossRefGoogle Scholar
  26. 26.
    Houssami N, Irwig L, Simpson JM et al (2003) Sydney Breast Imaging Accuracy Study: comparative sensitivity and specificity of mammography and sonography in young women with symptoms. AJR Am J Roentgenol 180:935–940PubMedGoogle Scholar
  27. 27.
    Houssami N, Irwig L, Loy C (2002) Accuracy of combined breast imaging in young women. Breast 11:36–40PubMedCrossRefGoogle Scholar
  28. 28.
    Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225:165–175PubMedCrossRefGoogle Scholar
  29. 29.
    Tardivon A, Athanasiou A, Ollivier L et al (2007) [Indications of MRI in the initial local staging of early-stage breast cancer.] Gynecol Obstet Fertil 35:457–460 [in French]PubMedCrossRefGoogle Scholar
  30. 30.
    Boetes C, Veltman J (2005) Screening women at increased risk with MRI. Cancer Imaging 5(Spec no. A):S10–S15PubMedCrossRefGoogle Scholar
  31. 31.
    Gomez SL, France AM, Lee MM (2004) Socioeconomic status, immigration/acculturation, and ethnic variations in breast conserving surgery, San Francisco Bay area. Ethn Dis 14:134–140PubMedGoogle Scholar
  32. 32.
    Lantz PV, Zemencuk JK, Katz SJ (2002) Is mastectomy overused? A call for an expanded research agenda. Health Serv Res 37:417–431PubMedCrossRefGoogle Scholar
  33. 33.
    Fung KW, Lau Y, Fielding R et al (2001) The impact of mastectomy, breast-conserving treatment and immediate breast reconstruction on the quality of life of Chinese women. Aust N Z J Surg 71:202–206CrossRefGoogle Scholar
  34. 34.
    Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 16:177–182PubMedGoogle Scholar
  35. 35.
    Madan AK, Aliabadi-Wahle S, Beech DJ (2001) Age bias: a cause of underutilization of breast conservation treatment. J Cancer Educ 16:29–32PubMedGoogle Scholar
  36. 36.
    Woon YY, Chan MY (2005) Breast conservation surgery–the surgeon’s factor. Breast 14:131–135PubMedCrossRefGoogle Scholar
  37. 37.
    Menard S, Casalini P, Cascinelli N et al (2000) Breast carcinoma in young patients. Lancet 356:1113PubMedCrossRefGoogle Scholar
  38. 38.
    Early Breast Cancer Trialists’ Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet 352:930–942CrossRefGoogle Scholar
  39. 39.
    NIH Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Bethesda, Maryland, June 18–21, 1990. J Natl Cancer Inst Monogr 1992:1–187Google Scholar
  40. 40.
    Lazovich D, Solomon CC, Thomas DB et al (1999) Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer 86:628–637PubMedCrossRefGoogle Scholar
  41. 41.
    Maggard MA, O’Connell JB, Lane KE et al (2003) Do young breast cancer patients have worse outcomes? J Surg Res 113:109–113PubMedCrossRefGoogle Scholar
  42. 42.
    Guerra I, Algorta J, Diaz de Otazu R et al (2003) Immunohistochemical prognostic index for breast cancer in young women. Mol Pathol 56:323–327PubMedCrossRefGoogle Scholar
  43. 43.
    Livi L, Saieva C, Detti B et al (2007) Loco-regional recurrence in 2064 patients with breast cancer treated with mastectomy without adjuvant radiotherapy. Eur J Surg Oncol 33:977–981PubMedCrossRefGoogle Scholar
  44. 44.
    Chung M, Chang HR, Bland KI et al (1996) Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 77:97–103PubMedCrossRefGoogle Scholar
  45. 45.
    Feldman AL, Welch JP (1998) Long-term outcome in women less than 30 years of age with breast cancer. J Surg Oncol 68:193–198PubMedCrossRefGoogle Scholar
  46. 46.
    Goldstein NS, Vicini FA, Kestin LL et al (2000) Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age. Cancer 88:2553–2560PubMedCrossRefGoogle Scholar
  47. 47.
    Bonnier P, Romain S, Charpin C et al (1995) Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer 62:138–144PubMedCrossRefGoogle Scholar
  48. 48.
    Menard S, Fortis S, Castiglioni F et al (2001) HER2 as a prognostic factor in breast cancer. Oncology 61(Suppl 2):67–72PubMedGoogle Scholar
  49. 49.
    Leung GM, Thach TQ, Lam TH et al (2002) Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis. Br J Cancer 87:982–988PubMedCrossRefGoogle Scholar
  50. 50.
    Pratap R, Shousha S (1998) Breast carcinoma in women under the age of 50: relationship between p53 immunostaining, tumour grade, and axillary lymph node status. Breast Cancer Res Treat 49:35–39PubMedCrossRefGoogle Scholar
  51. 51.
    Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97:134–147PubMedCrossRefGoogle Scholar
  52. 52.
    Dubsky PC, Gnant MF, Taucher S et al (2002) Young age as an independent adverse prognostic factor in premenopausal patients with breast cancer. Clin Breast Cancer 3:65–72PubMedCrossRefGoogle Scholar
  53. 53.
    Cristofanilli M, Gonzalez-Angulo A, Sneige N et al (2005) Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23:41–48PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Ava Kwong
    • 1
    • 2
    • 3
  • Polly Cheung
    • 1
  • Stephanie Chan
    • 1
  • Silvia Lau
    • 1
  1. 1.Breast Care CenterHong Kong Sanatorium and HospitalHappy ValleyChina
  2. 2.Department of SurgeryUniversity of Stanford Medical SchoolStanfordUSA
  3. 3.Division of Breast SurgeryThe University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalPokfulamChina

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