Advertisement

World Journal of Surgery

, Volume 34, Issue 7, pp 1427–1433 | Cite as

Breast Cancer in Young Women in a Limited-Resource Environment

  • Sarinah Basro
  • Justus P. Apffelstaedt
Article

Abstract

Background

Despite the higher incidence of breast cancer in young women in developing countries, there is a paucity of data on their management. We present the clinicopathological features and outcome of treatment of women 35 years or younger with breast cancer in a resource-restricted environment.

Methods

A total of 141 patients who were diagnosed with primary breast cancer at 35 years or younger from January 2000 to June 2008 were retrieved from the cancer registry of a breast clinic at a tertiary hospital and a private breast health center in South Africa. Clinicopathological features, treatment, and survival were analyzed.

Results

Two patients presented with TNM stage 0 (1.4%), 14 with stage I (9.9%), 47 with stage II (33.35%), 47 with stage III (33.3%), and 31 with stage IV (21.9%). Tumor grade was 3 in 47%, grade 2 in 37%, and grade 1 in 16% of patients. One hundred and four patients with stage 0–III disease underwent treatment with curative intent, 83 had a mastectomy, and 12 had breast-conserving surgery. Ninety patients (86.5%) had chemotherapy, 68 (65.4%) had radiotherapy, and 50 (48.1%) had hormonal therapy. Of 93 patients who completed primary therapy, 4 developed contralateral cancers, 3 had locoregional recurrence, 8 developed synchronous locoregional and distant recurrence, and 19 relapsed with distant metastasis only. The 2-year disease-free and overall survival for stage 0–III disease was 48 and 56%, respectively.

Conclusions

Young women with breast cancer in a resource-limited environment have similar adverse clinicopathological features to those in developed countries. Their disease is more advanced at presentation with poorer outcome. Increased awareness, better systemic therapy, and more comprehensive genetic studies are essential to improve the dismal outcome.

Keywords

Breast Cancer BRCA Mutation Breast Health Private Center Ovarian Function Suppression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Colleoni M, Rotmensz N, Robertson C et al (2002) Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol 13(2):273–279CrossRefPubMedGoogle Scholar
  2. 2.
    Kroman N, Jensen MB, Wohlfahrt J et al (2000) Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 320(7233):474–478CrossRefPubMedGoogle Scholar
  3. 3.
    Kwong A, Cheung P, Chan S et al (2008) Breast cancer in Chinese women younger than age 40: are they different from their older counterparts? World J Surg 32(12):2554–2561CrossRefPubMedGoogle Scholar
  4. 4.
    Chung M, Chang HR, Bland KI et al (1996) Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 77(1):97–103CrossRefPubMedGoogle Scholar
  5. 5.
    Yildirim E, Dalgic T, Berberoglu U (2000) Prognostic significance of young age in breast cancer. J Surg Oncol 74(4):267–272CrossRefPubMedGoogle Scholar
  6. 6.
    Gonzalez-Angulo AM, Broglio K, Kau SW et al (2005) Women age < or = 35 years with primary breast carcinoma: disease features at presentation. Cancer 103(12):2466–2472CrossRefPubMedGoogle Scholar
  7. 7.
    Hartley MC, McKinley BP, Rogers EA et al (2006) Differential expression of prognostic factors and effect on survival in young (< or = 40) breast cancer patients: a case-control study. Am Surg 72(12):1189–1194PubMedGoogle Scholar
  8. 8.
    Winchester DP, Osteen RT, Menck HR (1996) The National Cancer Data Base report on breast carcinoma characteristics and outcome in relation to age. Cancer 78(8):1838–1843CrossRefPubMedGoogle Scholar
  9. 9.
    Feldman AL, Welch JP (1998) Long-term outcome in women less than 30 years of age with breast cancer. J Surg Oncol 68(3):193–198CrossRefPubMedGoogle Scholar
  10. 10.
    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(1):65–72CrossRefPubMedGoogle Scholar
  11. 11.
    Xiong Q, Valero V, Kau V et al (2001) Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M.D. Anderson Cancer Center experience. Cancer 92(10):2523–2528CrossRefPubMedGoogle Scholar
  12. 12.
    Gajdos C, Tartter PI, Bleiweiss IJ et al (2000) Stage 0 to stage III breast cancer in young women. J Am Coll Surg 190(5):523–529CrossRefPubMedGoogle Scholar
  13. 13.
    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(5):888–894PubMedGoogle Scholar
  14. 14.
    Peto J, Collins N, Barfoot R et al (1999) Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer. J Natl Cancer Inst 91(11):943–949CrossRefPubMedGoogle Scholar
  15. 15.
    FitzGerald MG, MacDonald DJ, Krainer M et al (1996) Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast cancer. N Engl J Med 334(3):143–149CrossRefPubMedGoogle Scholar
  16. 16.
    Langston AA, Malone KE, Thompson JD et al (1996) BRCA1 mutations in a population-based sample of young women with breast cancer. N Engl J Med 334(3):137–142CrossRefPubMedGoogle Scholar
  17. 17.
    Turchetti D, Cortesi L, Federico M et al (2000) BRCA1 mutations and clinicopathological features in a sample of Italian women with early-onset breast cancer. Eur J Cancer 36(16):2083–2089CrossRefPubMedGoogle Scholar
  18. 18.
    Sng JH, Chang J, Feroze F et al (2000) The prevalence of BRCA1 mutations in Chinese patients with early onset breast cancer and affected relatives. Br J Cancer 82(3):538–542CrossRefPubMedGoogle Scholar
  19. 19.
    Bergthorsson JT, Ejlertsen B, Olsen JH et al (2001) BRCA1 and BRCA2 mutation status and cancer family history of Danish women affected with multifocal or bilateral breast cancer at a young age. J Med Genet 38(6):361–368CrossRefPubMedGoogle Scholar
  20. 20.
    Carlson RW, Anderson BO, Chopra R et al (2003) Treatment of breast cancer in countries with limited resources. Breast J 9(Suppl 2):S67–S74CrossRefPubMedGoogle Scholar
  21. 21.
    Eniu A, Carlson RW, Aziz Z et al (2006) Breast cancer in limited-resource countries: treatment and allocation of resources. Breast J 12(Suppl 1):S38–S53CrossRefPubMedGoogle Scholar
  22. 22.
    Singletary SE, Allred C, Ashley P et al (2002) Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20(17):3628–3636CrossRefPubMedGoogle Scholar
  23. 23.
    Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19(5):403–410CrossRefPubMedGoogle Scholar
  24. 24.
    Agenbag GM, Warnich L, Scholtz CL et al (2005) BRCA1 and BRCA2 mutation screening facilitates an improved diagnostic service for breast cancer in South Africa. ThesisGoogle Scholar
  25. 25.
    Reeves MD, Yawitch TM, van der Merwe NC et al (2004) BRCA1 mutations in South African breast and/or ovarian cancer families: evidence of a novel founder mutation in Afrikaner families. Int J Cancer 110(5):677–682CrossRefPubMedGoogle Scholar
  26. 26.
    Bland M (1995) Life-table analysis and Kaplan–Meier graph. An introduction to medical statistics, 2nd edn. Oxford University Press, New York, pp 279–286Google Scholar
  27. 27.
    Amir H, Kwesigabo G, Aziz MR et al (1996) Breast cancer and conservative surgery in sub-Saharan Africa. East Afr Med J 73(2):83–87PubMedGoogle Scholar
  28. 28.
    Adesunkanmi AR, Lawal OO, Adelusola KA et al (2006) The severity, outcome and challenges of breast cancer in Nigeria. Breast 15(3):399–409CrossRefPubMedGoogle Scholar
  29. 29.
    Walker AR, Adam FI, Walker BF (2004) Breast cancer in black African women: a changing situation. J R Soc Health 124(2):81–85CrossRefGoogle Scholar
  30. 30.
    Hoffman M, de Pinho H, Cooper D et al (2000) Breast cancer incidence and determinants of cancer stage in the Western Cape. S Afr Med J 90(12):1212–1216PubMedGoogle Scholar
  31. 31.
    Agarwal G, Pradeep PV, Aggarwal V et al (2007) Spectrum of breast cancer in Asian women. World J Surg 31(5):1031–1040CrossRefPubMedGoogle Scholar
  32. 32.
    Adebamowo CA, Adekunle OO (1999) Case-controlled study of the epidemiological risk factors for breast cancer in Nigeria. Br J Surg 86(5):665–668CrossRefPubMedGoogle Scholar
  33. 33.
    Vorobiof DA, Sitas F, Vorobiof G (2001) Breast cancer incidence in South Africa. J Clin Oncol 19(18 Suppl):125S–127SPubMedGoogle Scholar
  34. 34.
    Aebi S, Gelber S, Castiglione-Gertsch M et al (2000) Is chemotherapy alone adequate for young women with oestrogen-receptor-positive breast cancer? Lancet 355(9218):1869–1874CrossRefPubMedGoogle Scholar
  35. 35.
    Colleoni M, Rotmensz N, Peruzzotti G et al (2006) Role of endocrine responsiveness and adjuvant therapy in very young women (below 35 years) with operable breast cancer and node negative disease. Ann Oncol 17(10):1497–1503CrossRefPubMedGoogle Scholar
  36. 36.
    Aebi S (2005) Special issues related to the adjuvant therapy in very young women. Breast 14(6):594–599CrossRefPubMedGoogle Scholar
  37. 37.
    Early Breast Cancer Trialists’ Collaborative Group (1996) Ovarian ablation in early breast cancer: overview of the randomised trials. Lancet 348:1189–1196CrossRefGoogle Scholar
  38. 38.
    Voogd AC, Nielsen M, Peterse JL et al (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 19(6):1688–1697PubMedGoogle Scholar
  39. 39.
    Kurtz JM, Jacquemier J, Amalric R et al (1990) Why are local recurrences after breast-conserving therapy more frequent in younger patients? J Clin Oncol 8(4):591–598PubMedGoogle Scholar
  40. 40.
    Arriagada R, Le MG, Contesso G et al (2002) Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol 13(9):1404–1413CrossRefPubMedGoogle Scholar
  41. 41.
    Kurtz JM, Spitalier JM, Amalric R et al (1988) Mammary recurrences in women younger than forty. Int J Radiat Oncol Biol Phys 15(2):271–276PubMedGoogle Scholar
  42. 42.
    Aziz Z, Iqbal J, Akram M (2008) Effect of social class disparities on disease stage, quality of treatment and survival outcomes in breast cancer patients from developing countries. Breast J 14(4):372–375CrossRefPubMedGoogle Scholar
  43. 43.
    Anim JT (1993) Breast cancer in sub-Saharan African women. Afr J Med Med Sci 22(1):5–10PubMedGoogle Scholar
  44. 44.
    Murray EM (2003) Medical and radiation oncology for breast cancer in developing countries with particular reference to locally advanced breast cancer. World J Surg 27(8):924–927CrossRefPubMedGoogle Scholar
  45. 45.
    Sandelin K, Apffelstaedt JP, Abdullah H et al (2002) Breast Surgery International—breast cancer in developing countries. Scand J Surg 91(3):222–226PubMedGoogle Scholar
  46. 46.
    Bear HD, Anderson S, Brown A et al (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21(22):4165–4174CrossRefPubMedGoogle Scholar
  47. 47.
    Smith IC, Heys SD, Hutcheon AW et al (2002) Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 20(6):1456–1466CrossRefPubMedGoogle Scholar
  48. 48.
    Evans TR, Yellowlees A, Foster E et al (2005) Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an Anglo-Celtic cooperative oncology group study. J Clin Oncol 23(13):2988–2995CrossRefPubMedGoogle Scholar
  49. 49.
    Buzdar AU, Ibrahim NK, Francis D et al (2005) Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23(16):3676–3685CrossRefPubMedGoogle Scholar
  50. 50.
    Mohsin SK, Weiss HL, Gutierrez MC et al (2005) Neoadjuvant trastuzumab induces apoptosis in primary breast cancers. J Clin Oncol 23(11):2460–2468CrossRefPubMedGoogle Scholar
  51. 51.
    Malone KE, Daling JR, Thompson JD et al (1998) BRCA1 mutations and breast cancer in the general population: analyses in women before age 35 years and in women before age 45 years with first-degree family history. JAMA 279(12):922–929CrossRefPubMedGoogle Scholar
  52. 52.
    Malone KE, Daling JR, Neal C et al (2000) Frequency of BRCA1/BRCA2 mutations in a population-based sample of young breast carcinoma cases. Cancer 88(6):1393–1402CrossRefPubMedGoogle Scholar
  53. 53.
    Uhrhammer N, Abdelouahab A, Lafarge L et al (2008) BRCA1 mutations in Algerian breast cancer patients: high frequency in young, sporadic cases. Int J Med Sci 5(4):197–202PubMedGoogle Scholar
  54. 54.
    Gao Q, Adebamowo CA, Fackenthal J et al (2000) Protein truncating BRCA1 and BRCA2 mutations in African women with pre-menopausal breast cancer. Hum Genet 107(2):192–194CrossRefPubMedGoogle Scholar
  55. 55.
    Awadelkarim KD, Aceto G, Veschi S et al (2007) BRCA1 and BRCA2 status in a Central Sudanese series of breast cancer patients: interactions with genetic, ethnic and reproductive factors. Breast Cancer Res Treat 102(2):189–199CrossRefPubMedGoogle Scholar
  56. 56.
    Anderson BO, Yip CH, Ramsey SD et al (2006) Breast cancer in limited-resource countries: health care systems and public policy. Breast J 12(Suppl 1):S54–S69CrossRefPubMedGoogle Scholar
  57. 57.
    Smith RA, Caleffi M, Albert US et al (2006) Breast cancer in limited-resource countries: early detection and access to care. Breast J 12(Suppl 1):S16–S26CrossRefPubMedGoogle Scholar
  58. 58.
    Albert US, Schulz KD (2003) Clinical breast examination: what can be recommended for its use to detect breast cancer in countries with limited resources? Breast J 9(Suppl 2):S90–S93CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of StellenboschCape TownSouth Africa

Personalised recommendations