Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 59–67 | Cite as

Where youth matters—clinicopathologic characteristics and emerging trends in treatment and outcomes in young Irish women with breast cancer

  • Megan GreallyEmail author
  • Jennifer Kielty
  • Geoffrey A. Watson
  • Geoffrey Das
  • Christina Malouf
  • Lynda McSorley
  • Niamh Coleman
  • Cecily Quinn
  • Enda W. McDermott
  • Giuseppe Gullo
  • John Crown
  • Ruth S. Prichard
  • Catherine M. Kelly
  • Janice M. Walshe
Original Article

Abstract

Background

Young women with breast cancer (YWBC) represent 7–12% of breast cancer diagnoses and ostensibly have more biologically aggressive subtypes with higher relapse and mortality rates. We studied the clinical and pathological characteristics in YWBC and examined how outcomes and treatment have evolved.

Methods

YWBC were identified from pathology databases at two tertiary centers. Patients were divided into two cohorts: those diagnosed from 2000 to 2005 (C1) and from 2006 to 2015 (C2). Data were retrieved from clinical, radiology, and histology databases. Statistical analysis was performed using R® (V3.2.0).

Results

We identified 345 patients. Median age was 36 years (23–39 years). Mastectomy was performed in 232 patients (67.2%) and axillary lymph node clearance (ALNC) in 207 patients (60% [C1 82.7 vs. C2: 49.4%, p < 0.001]). One hundred-seventy patients (49%) were ER + HER2−, 88 (25.5%) were HER2+, and 58 (16.8%) were triple negative. Eighty patients (23.2%) received neoadjuvant therapy. Pathological complete response rates were statistically similar between C1 and C2 [C1 1 (0.9%) vs C2 16 (6.8%) p = 0.1]. Distant relapse occurred in 59 (19%) patients. There was a higher relapse rate (RR) in C1 [27 (32.1%) vs. 32 (15.7%), p < 0.002). HER2+ and ER+ HER2− patients in C1 had higher RRs than C2. Median overall survival in patients with metastatic disease was 29 months (range 2–119 months).

Conclusion

Locally advanced disease was more prevalent in YWBC. Mastectomy and ALNC rates were high and most received multimodal treatment. The extent of axillary surgery declined over time. Outcomes were unchanged in triple negative patients. These remain a priority for research.

Keywords

Axillary lymph node clearance Breast cancer Chemotherapy Endocrine therapy Locally advanced Mastectomy Triple negative Young women 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Janice M. Walshe has served as consultant in an advisory role to Roche, Genomic Health, Pfizer. Dr. Giuseppe Gullo has served as a consultant in an advisory role to Roche, Novartis, BMS.

There are no other potential conflicts of interest.

References

  1. 1.
    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 16:7–14Google Scholar
  2. 2.
    Ries LAG, Eisner MP, Kosary C, et al. (2005) SEER Cancer Statistics Review, 1975–2002, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2002/, based on November 2004 SEER data submission, posted to the SEER web site 2005
  3. 3.
    Brinton LA, Sherman ME, Carreon JD, Anderson WF (2008) Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst 100(22):1643–1648.  https://doi.org/10.1093/jnci/djn344 Google Scholar
  4. 4.
    Johnson RH, Chien FL, Bleyer A (2013) Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. J Am Med Assoc 309(8):800–805.  https://doi.org/10.1001/jama.2013.776. Google Scholar
  5. 5.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30.  https://doi.org/10.3322/caac.21166. Google Scholar
  6. 6.
    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(1):109–113Google Scholar
  7. 7.
    Kheirelseid EAH, Boggs JM, Curran C et al (2011) Younger age as a prognostic indicator in breast cancer: a cohort study. BMC Cancer 11:383.  https://doi.org/10.1186/1471-2407-11-383 Google Scholar
  8. 8.
    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(3):341–337.  https://doi.org/10.1016/j.jamcollsurg.2008.12.001 Google Scholar
  9. 9.
    de la Rochefordiere A, Asselain B, Campana F et al (1993) Age as prognostic factor in premenopausal breast carcinoma. Lancet 341(8852):1039–1043Google Scholar
  10. 10.
    Bonnier P, Romain S, Charpin C, Lejeune C, Tubiana N, Martin PM, Piana L (1995) Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer 62(2):138–144Google Scholar
  11. 11.
    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(11):e7695.  https://doi.org/10.1371/journal.pone.0007695 Google Scholar
  12. 12.
    Ribnikar D, Ribeiro JM, Pinto D, Sousa B, Pinto AC, Gomes E, Moser EC, Cardoso MJ, Cardoso F (2015) Breast cancer under age 40: a different approach. Curr Treat Options in Oncol 16(4):16.  https://doi.org/10.1007/s11864-015-0334-8 Google Scholar
  13. 13.
    Azim HA, Partridge AH (2014) Biology of breast cancer in young women. Breast Cancer Res 16(4):427.  https://doi.org/10.1186/s13058-014-0427-5 Google Scholar
  14. 14.
    Keegan TH, DeRouen MC, Press DJ et al (2012) Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res 14(2):55.  https://doi.org/10.1186/bcr3156 Google Scholar
  15. 15.
    Yanagawa M, Ikemot K, Kawauchi S, Furuya T, Yamamoto S, Oka M, Oga A, Nagashima Y, Sasaki K (2012) Luminal A and luminal B (HER2 negative) subtypes of breast cancer consist of a mixture of tumours with different genotype. BMC Res Notes 5:376.  https://doi.org/10.1186/1756-0500-5-376 Google Scholar
  16. 16.
    Voduc KD, Cheang MC, Tyldesley S et al (2010) Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 28(10):1684–1691.  https://doi.org/10.1200/JCO.2009.24.9284 Google Scholar
  17. 17.
    Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, Brachtel EF, Schapira L, Come SE, Winer EP, Partridge AH (2012) Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat 131(3):1061–1066.  https://doi.org/10.1007/s10549-011-1872-9 Google Scholar
  18. 18.
    Bacchi LM, Corpa M, Santos PP, Bacchi CE, Carvalho FM (2010) Estrogen receptor-positive breast carcinomas in younger women are different from those of older women: a pathological and immunohistochemical study. Breast 19(2):137–141.  https://doi.org/10.1016/j.breast.2010.01.002 Google Scholar
  19. 19.
    Caldarella A, Crocetti E, Bianchi S, Vezzosi V, Urso C, Biancalani M, Zappa M (2011) Female breast cancer status according to ER, PR and HER2 expression: a population based analysis. Pathol Oncol Res 17(3):753–758.  https://doi.org/10.1007/s12253-011-9381-z Google Scholar
  20. 20.
    Tamimi RM, Baer HJ, Marotti J et al (2008) Comparison of molecular phenotypes of ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res 10(4):R67.  https://doi.org/10.1186/bcr2128 Google Scholar
  21. 21.
    Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL, Geradts J, Cheang MCU, Nielsen TO, Moorman PG, Earp HS, Millikan RC (2006) Race, breast cancer subtypes, and survival in the Caroline breast cancer study. JAMA 295(21):2492–2502Google Scholar
  22. 22.
    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, POSH Study Steering Group (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(13):978–988.  https://doi.org/10.1093/jnci/djt134 Google Scholar
  23. 23.
    Reyna C, Lee MC (2014) Breast cancer in young women: special considerations in multidisciplinary care. J Multidiscip Healthc 29(7):419–429.  https://doi.org/10.2147/JMDH.S49994. Google Scholar
  24. 24.
    Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
  25. 25.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717Google Scholar
  26. 26.
    Rakha EA, Putti TC, Abd El-Rehim DM et al (2006) Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentiation. J Pathol 208(4):495–506Google Scholar
  27. 27.
    Louwman MW, Vriezen M, van Beek MW et al (2007) Uncommon breast tumors in perspective: incidence, treatment and survival in the Netherlands. Int J Cancer 121(1):127–135Google Scholar
  28. 28.
    Weigelt B, Geyer FC, Reis-Filho JS (2010) Histological types of breast cancer: how special are they? Mol Oncol 4(3):192–208.  https://doi.org/10.1016/j.molonc.2010.04.004 Google Scholar
  29. 29.
    Lizarraga I, Schroeder MC, Weigel RJ, Thomas A (2015) Surgical management of breast cancer in 2010-2011 SEER registries by hormone and HER2 receptor status. Ann Surg Oncol 22(Suppl 3):S566–S572.  https://doi.org/10.1245/s10434-015-4591-3. Google Scholar
  30. 30.
    Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J (2014) Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 149(3):267–274.  https://doi.org/10.1001/jamasurg.2013.3049 Google Scholar
  31. 31.
    Han W, Kang SY, Korean Breast Cancer Society (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(1):193–200.  https://doi.org/10.1007/s10549-009-0388-z Google Scholar
  32. 32.
    de Deus Moura R, Carvalho M, Bacchi CE (2015) Breast cancer in very young women: clinicopathological study of 149 patients ≤25 years old. Breast 24(4):461–467.  https://doi.org/10.1016/j.breast.2015.04.002 Google Scholar
  33. 33.
    Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Morrow M (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA 318(10):918–926.  https://doi.org/10.1001/jama/2017/11470 Google Scholar
  34. 34.
    Kroman N, Holtveg H, Wohlfahrt J, Jensen MB, 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(4):688–693Google Scholar
  35. 35.
    Mahmood U, Morris C, Neuner G, Koshy M, Kesmodel S, Buras R, Chumsri S, Bao T, Tkaczuk K, Feigenberg S (2012) Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer. Int J Radiat Oncol Biol Phys 83(5):1387–1393.  https://doi.org/10.1016/j.ijrobp.2011.10.075 Google Scholar
  36. 36.
    Barton MK (2015) Mastectomy and breast-conserving therapy confer equivalent outcomes in young women with early-stage breast cancer. CA Cancer J Clin 65(5):335–336.  https://doi.org/10.3322/caac.21289 Google Scholar
  37. 37.
    Sheridan W, Scott T, Caroline S, Yvonne Z, Vanessa B, David V, Karen G, Stephen C (2014) Breast cancer in young women: have the prognostic implications of breast cancer subtypes changed over time? Breast Cancer Res Treat 147(3):617–629.  https://doi.org/10.1007/s10549-014-3125-1 Google Scholar
  38. 38.
    Lee MK, Varzi LA, Chung DU et al (2015) The effect of young age in hormone receptor positive breast cancer. Biomed Res Int 2015:325715.  https://doi.org/10.1155/2015/325715 Google Scholar
  39. 39.
    Kroman N, Jensen MB, Wohlfahrt J et al (2003) Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 320(7233):474–478Google Scholar
  40. 40.
    Gnant M, Mlineritsch B, Stoeger H (2015) Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozole plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian breast and colorectal cancer study group trial 12. Ann Oncol 26(2):313–320.  https://doi.org/10.1093/annonc/mdu544 Google Scholar
  41. 41.
    Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, Hiller W, Fisher ER, Wickerham DL, Bryant J, Wolmark N (2004) A multigene assay to predict recurrence of tamoxifen-treated, node negative breast cancer. N Engl J Med 351(27):2817–2826Google Scholar
  42. 42.
    Partridge AH, Pagoni O, Abulkhair O et al (2014) First international consensus guidelines for breast cancer in young women (BCY1). Breast 23(3):209–220.  https://doi.org/10.1016/j.breast.2014.03.011 Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Megan Greally
    • 1
    • 2
    Email author
  • Jennifer Kielty
    • 1
  • Geoffrey A. Watson
    • 3
  • Geoffrey Das
    • 1
  • Christina Malouf
    • 1
  • Lynda McSorley
    • 3
  • Niamh Coleman
    • 1
  • Cecily Quinn
    • 1
  • Enda W. McDermott
    • 1
  • Giuseppe Gullo
    • 1
  • John Crown
    • 1
  • Ruth S. Prichard
    • 1
  • Catherine M. Kelly
    • 3
  • Janice M. Walshe
    • 1
  1. 1.Department of Medical OncologySt. Vincents University HospitalDublin 4Ireland
  2. 2.Gastrointestinal Oncology, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Medical OncologyMater Misercordiae University HospitalDublin 7Ireland

Personalised recommendations