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Annals of Surgical Oncology

, Volume 2, Issue 5, pp 407–415 | Cite as

Improved survival in young women with breast cancer

  • Benjamin O. Anderson
  • Ruby T. Senie
  • John T. Vetto
  • George Y. Wong
  • Beryl McCormick
  • Patrick I. Borgen
Original Articles

Abstract

Background: Young age has been hypothesized to be an adverse prognostic factor for women with breast cancer. This association, based on historical data, may not reflect recent advances in breast cancer management.

Methods: A retrospective study was conducted of all women age 30 or younger who underwent definitive operation at our institution for primary operable breast carcinoma during one of two consecutive 20-year periods (1950–1969 or 1970–1989). All cancers were restaged according to current staging criteria. Actuarial survival and recurrence-free survival rates from the two patient eras were compared with each other and with published statistics for older breast cancer patients.

Results: Eligibility criteria were met by 81 women from the 1950–1969 era and 146 women from the 1970–1989 era. Histologic diagnoses, tumor sizes, incidence of axillary nodal metastases, number of positive nodes, and American Joint Committee on Cancer stage at presentation were similarly distributed in the two eras. Despite these similarities, improved survival (p=0.009) was observed in the later era. Local recurrences were also more common (p<0.05) in the later era in association with less extensive resections. These local recurrences had an adverse impact on recurrence-free survival in the later era, but no concomitant decrease in overall survival was observed. Node-positive patients who received chemotherapy demonstrated a trend toward improved survival (p=0.06) compared with node-positive patients who did not. Survival for patients in the later era was similar to that for older women as reported in other published series.

Conclusions: The stage of presentation of breast cancer in women 30 years or younger appears unchanged from prior decades, but survival has improved in association with the use of less extensive surgical resections and the introduction of cytotoxic chemotherapy. With current treatment, primary operable breast cancer in young women appears to have a similar prognosis to breast cancer in older women.

Key Words

Breast cancer Young age Local recurrence Chemotherapy 

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References

  1. 1.
    Ewing J. Epithelial and other tumors of the breast. In: Ewing J, ed.Neoplastic diseases, a treatise on tumors, 4th ed. Philadelphia: WB Saunders, 1940:587–8.Google Scholar
  2. 2.
    Muscolino G, Villani C, Bedini AV, Luini A, Salvadori B. Young age is not an ominous prognostic factor in breast cancer patients.Tumori 1987;73:233–5.PubMedGoogle Scholar
  3. 3.
    Backhouse CM, Lloyd-Davies ERV, Shousha S, Burn JI. Carcinoma of the breast in women aged 35 or less.Br J Surg 1987;74:591–3.PubMedGoogle Scholar
  4. 4.
    Editorial. Breast cancer in young women.Br Med J 1975;2:649–50.Google Scholar
  5. 5.
    Epstein R. Analysis of natural history of breast cancer in young women.Lancet 1992;340:1287.PubMedGoogle Scholar
  6. 6.
    Swanson GM. Breast cancer in younger women: survival patterns.Female Patient 1993;18:53–6.Google Scholar
  7. 7.
    Adami HO, Malker B, Holmberg L, Persson I, Stone B. The relation between survival and age at diagnosis in breast cancer.New Engl J Med 1986;315:559–63.PubMedGoogle Scholar
  8. 8.
    Ferguson CM, Powell RW. Breast masses in young women.Arch Surg 1989;124:1338–41.PubMedGoogle Scholar
  9. 9.
    Breast cancer in young women: more questions than answers.Oncol Bull 1993;16:14–8.Google Scholar
  10. 10.
    Qualters JR, Lee NC, Smith RA, Aubert RE. Breast and cervical cancer surveillance, United States, 1973–1987.Morbidity Mortality Weekly Rep 1992;41:1–15.Google Scholar
  11. 11.
    Lee CG, McCormick B, Mazumdar M, Vetto J, Borgen PI. 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 1992;23:969–75.PubMedGoogle Scholar
  12. 12.
    Breast cancer staging. In: American Joint Committee on Cancer.Manual for staging of cancer, 4th ed. Philadelphia: JB Lippincott, 1992:149–54.Google Scholar
  13. 13.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.Am Stat Assoc J 1958;53:457–81.Google Scholar
  14. 14.
    Glantz SA. The chi-square test statistic. In:Primer of biostatistics, 2nd ed. New York: McGraw-Hill, 1987:122–6.Google Scholar
  15. 15.
    Schottenfeld D, Nash AG, Robbins GF, Beattie EJ. Ten-year results of the treatment of primary operable breast carcinoma: a summary of 304 patients evaluated by the TNM system.Cancer 1976;38:1001–7.PubMedGoogle Scholar
  16. 16.
    Cascinelli N, Singletary E, Greco M, et al. Long-term survival and prognostic factors for 2170 breast cancer patients treated at two cancer centers.Tumori 1989;75:123–31.PubMedGoogle Scholar
  17. 17.
    Fisher B, Anderson S, Fisher ER, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy.Lancet 1991;338(8763):327–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Smart CR, Hartmann WH, Beahrs OH, Garfinkel L. Insights into breast cancer screening of younger women.Cancer Suppl 1993;72:1449–56.Google Scholar
  19. 19.
    Liberman L, Giess C, Borgen PI, Deutch BM, Dershaw DD. Presented at the 78th Scientific Assembly of the Radiologic Society of North America, Chicago, Illinois, 1992.Google Scholar
  20. 20.
    Adami HO, Hansen J, Jung B, Rimsten A. Familiality in breast cancer: a case-control study in a Swedish population.Br J Cancer 1980;42:71–7.PubMedGoogle Scholar
  21. 21.
    Knudson AG Jr. Mutation and cancer: statistical study of retinoblastoma.Proc Natl Acad Sci USA 1971;68:820–3.PubMedGoogle Scholar
  22. 22.
    Senie RT, Simkovich A, Kinne DW, Borgen PI. Generational shifting in mean age at diagnosis of breast cancer [Abstract].Breast Cancer Res Treat 1993;27:173.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc 1995

Authors and Affiliations

  • Benjamin O. Anderson
    • 1
  • Ruby T. Senie
    • 1
  • John T. Vetto
    • 3
  • George Y. Wong
    • 4
  • Beryl McCormick
    • 2
  • Patrick I. Borgen
    • 1
  1. 1.From the Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew York
  2. 2.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew York
  3. 3.Division of General SurgeryOregon Health Sciences UniversityPortland
  4. 4.Strang Cancer Prevention CenterCornell UniversityNew York

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