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The Effect of Age on Outcomes After Neoadjuvant Chemotherapy for Breast Cancer



Younger women (age ≤ 40 years) with breast cancer undergoing neoadjuvant chemotherapy (NAC) have higher rates of pathologic complete response (pCR); however, it is unknown whether axillary or breast downstaging rates differ by age. In this study, we compared pCR incidence and surgical downstaging rates of the breast and axilla post NAC, between patients aged ≤ 40, 41–60, and ≥ 61 years.


We identified 1383 women with stage I–III breast cancer treated with NAC and subsequent surgery from November 2013 to December 2018. pCR and breast/axillary downstaging rates were assessed and compared across age groups.


Younger women were significantly more likely to have ductal histology, poorly differentiated tumors, and BRCA mutations; 35% of tumors were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2–), 36% were HER2-positive (HER2+), and 29% were triple negative (TN), with similar subtype distribution across age groups (p = 0.6). Overall, pCR rates did not differ by age, however among patients with TN tumors (n = 394), younger women had higher pCR rates (52% vs. 35% among those aged 41–60 years and 29% among those aged ≥61 years; p = 0.007) and were more likely to have tumors with high tumor-infiltrating lymphocyte (TIL) concentrations (p < 0.001). Downstaging to breast-conserving surgery (BCS) eligibility post NAC among initially BCS-ineligible patients was similar across age groups; younger women chose BCS less often (p < 0.001). Among cN1 patients (n = 813), 52% of women ≤40 years of age avoided axillary lymph node dissection (ALND) with NAC, versus 39% and 37% in the older groups (p < 0.001).


Younger women undergoing NAC for axillary downstaging were more likely to avoid ALND across all subtypes; however, overall pCR rates did not differ by age. Despite equivalent breast downstaging and BCS eligibility rates across age groups, younger women were less likely to undergo BCS.

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Correspondence to Audree B. Tadros MD.

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Conflict of interest All authors declared no conflict of interest.


The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. The study was presented in virtual poster format at the 22nd Annual Meeting of the American Society of Breast Surgeons, 29 April–2 May 2021. Monica Morrow has received honoraria from Exact Sciences and Roche, and Hong Zhang is a Consultant to Genentech/Roche and has received payment for consultation work. Francys C. Verdial, Anita Mamtani, Kate R. Pawloski, Varadan Sevilimedu, Timothy M. D’Alfonso, Mary L. Gemignani, Andrea V. Barrio, and Audree B. Tadros have no conflicts of interest to report.

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Verdial, F.C., Mamtani, A., Pawloski, K.R. et al. The Effect of Age on Outcomes After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 29, 3810–3819 (2022).

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  • Breast Cancer
  • Neoadjuvant chemotherapy
  • Young women
  • Breast cancer subtypes
  • pCR