Prognostic Factors Affecting Survival in Breast Cancer Patients Age 40 Or Younger

Abstract

Objectives: The aims of this study were to identify the factors affecting survival and disease-free survival (DFS) in invasive breast cancer patients who underwent surgery for breast cancer age 40 or younger. Methods: Medical records of 216 women with breast carcinoma at age 40 or younger who underwent surgery at our Institution between October 2005 and May 2017 were retrospectively reviewed. One hundred and eighty eight invasive breast cancer patients that were eligible were categorized according to their clinical and pathological features. Univariate analyses of survival and DFS were performed by the Kaplan–Meier method and the log-rank test. Independent prognostic and predictive factors affecting survival and DFS were assessed by Cox regression proportional hazard method. Results: 10-year survival and DFS were 85 and 74%, respectively. Axillary involvement, pathologic tumor size, HER 2 + subtype and Triple Negative subtype were found to be the prognostic factors that independently affected survival and DFS. Conclusions: The prognosis is worse in patients with axillary involvement, tumors larger than 2 cm, and HER 2+ and Triple Negative subtypes. These adverse prognostic factors should be considered during treatment and follow-up of patients age 40 or younger.

Keywords

• Breast cancer
• prognosis
• survival
• disease-free survival
• breast neoplasms

References

1. 1. World Health Organization I. Estimated number of new cases in 2018 GLOBOCAN web page: World Health Organization, IARC; 2018 [cited 2018]. Available from: https://gco.iarc.fr/today/online-analysis-table?v=2018&mode=cancer&mode_population=continents&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=5&group_cancer=1&include_nmsc=1&include_nmsc_other=1.
2. 2. Ozmen V, Ozmen T, Dogru V. Breast Cancer in Turkey; An Analysis of 20.000 Patients with Breast Cancer. Eur J Breast Health. 2019;15(3):141-6. Epub 2019/07/18. doi: 10.5152/ejbh.2019.4890. PubMed PMID: 31312788; PubMed Central PMCID: PMCPMC6619786.
3. 3. Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress RI, et al. Prospective observational study of breast cancer treatment outcomes for UK women aged 18-40 years at diagnosis: the POSH study. J Natl Cancer Inst. 2013;105(13):978-88. Epub 2013/06/01. doi: 10.1093/jnci/djt134. PubMed PMID: 23723422.
4. 4. Karihtala P, Winqvist R, Bloigu R, Jukkola-Vuorinen A. Long-term observational follow-up study of breast cancer diagnosed in women ≤40 years old. Breast (Edinburgh, Scotland). 2010;19(6):456-61. Epub 2010/06/24. doi: 10.1016/j.breast.2010.05.001. PubMed PMID: 20570150.
5. 5. Keegan TH, Press DJ, Tao L, DeRouen MC, Kurian AW, Clarke CA, et al. Impact of breast cancer subtypes on 3-year survival among adolescent and young adult women. Breast Cancer Res. 2013;15(5):R95. Epub 2013/10/18. doi: 10.1186/bcr3556. PubMed PMID: 24131591; PubMed Central PMCID: PMCPMC3978627.
6. 6. Mahmood U, Morris C, Neuner G, Koshy M, Kesmodel S, Buras R, et al. 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. 2012;83(5):1387-93. Epub 2012/02/04. doi: 10.1016/j.ijrobp.2011.10.075. PubMed PMID: 22300561.
7. 7. Hartley MC, McKinley BP, Rogers EA, Kalbaugh CA, Messich HS, Blackhurst DW, et al. Differential expression of prognostic factors and effect on survival in young (< or =40) breast cancer patients: a case-control study. The American surgeon. 2006;72(12):1189-94; discussion 94-5. Epub 2007/01/16. PubMed PMID: 17216817.
8. 8. Love RR, Duc NB, Dinh NV, Quy TT, Xin Y, Havighurst TC. Young age as an adverse prognostic factor in premenopausal women with operable breast cancer. Clinical breast cancer. 2002;2(4):294-8. Epub 2002/03/20. doi: 10.3816/cbc.2002.n.005. PubMed PMID: 11899361.

9. 9. Partridge AH, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, et al. The effect of age on delay in diagnosis and stage of breast cancer. Oncologist. 2012;17(6):775-82. Epub 2012/05/05. doi: 10.1634/theoncologist.2011-0469. PubMed PMID: 22554997; PubMed Central PMCID: PMCPMC3380876.
10. 10. Vogel JE, Chu C, McCullough M, Anderson E, Losken A, Carlson GW. Breast cancer in women under age 40 years: treatment by total mastectomy and reconstruction. Annals of plastic surgery. 2011;66(5):557-60. Epub 2011/04/01. doi: 10.1097/SAP.0b013e318216b648. PubMed PMID: 21451370.
11. 11. Zabicki K, Colbert JA, Dominguez FJ, Gadd MA, Hughes KS, Jones JL, et al. Breast cancer diagnosis in women < or = 40 versus 50 to 60 years: increasing size and stage disparity compared with older women over time. Ann Surg Oncol. 2006;13(8):1072-7. Epub 2006/07/26. doi: 10.1245/aso.2006.03.055. PubMed PMID: 16865599.
12. 12. Fredholm H, Magnusson K, Lindstrom LS, Garmo H, Falt SE, Lindman H, et al. Long-term outcome in young women with breast cancer: a population-based study. Breast Cancer Res Treat. 2016;160(1):131-43. Epub 2016/09/15. doi: 10.1007/s10549-016-3983-9. PubMed PMID: 27624330; PubMed Central PMCID: PMCPMC5050247.
13. 13. Yoshida M, Shimizu C, Fukutomi T, Tsuda H, Kinoshita T, Akashi-Tanaka S, et al. Prognostic factors in young Japanese women with breast cancer: prognostic value of age at diagnosis. Japanese journal of clinical oncology. 2011;41(2):180-9. Epub 2010/10/16. doi: 10.1093/jjco/hyq191. PubMed PMID: 20947623.
14. 14. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Annals of oncology : official journal of the European Society for Medical Oncology. 2011;22(8):1736-47. Epub 2011/06/29. doi: 10.1093/annonc/mdr304. PubMed PMID: 21709140; PubMed Central PMCID: PMCPMC3144634.
15. 15. Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2001;19(5):1539-69. Epub 2001/03/07. doi: 10.1200/jco.2001.19.5.1539. PubMed PMID: 11230499.
16. 16. Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Seminars in oncology. 2009;36(3):237-49. Epub 2009/05/23. doi: 10.1053/j.seminoncol.2009.03.001. PubMed PMID: 19460581; PubMed Central PMCID: PMCPMC2894028.
17. 17. Baselga J. Clinical trials of Herceptin(trastuzumab). European journal of cancer (Oxford, England : 1990). 2001;37 Suppl 1:S18-24. Epub 2001/02/13. PubMed PMID: 11167087.
18. 18. Goldhirsch A, Coates AS, Gelber RD, Glick JH, Thürlimann B, Senn HJ. First--select the target: better choice of adjuvant treatments for breast cancer patients. Annals of oncology : official journal of the European Society for Medical Oncology. 2006;17(12):1772-6. Epub 2006/10/31. doi: 10.1093/annonc/mdl398. PubMed PMID: 17071934.
19. 19. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thürlimann B, Senn HJ. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Annals of oncology : official journal of the European Society for Medical Oncology. 2007;18(7):1133-44. Epub 2007/08/07. doi: 10.1093/annonc/mdm271. PubMed PMID: 17675394.
20. 20. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. The New England journal of medicine. 2005;353(16):1659-72. Epub 2005/10/21. doi: 10.1056/NEJMoa052306. PubMed PMID: 16236737.
21. 21. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE, Jr., Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. The New England journal of medicine. 2005;353(16):1673-84. Epub 2005/10/21. doi: 10.1056/NEJMoa052122. PubMed PMID: 16236738.
22. 22. Smith I, Procter M, Gelber RD, Guillaume S, Feyereislova A, Dowsett M, et al. 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet (London, England). 2007;369(9555):29-36. Epub 2007/01/09. doi: 10.1016/s0140-6736(07)60028-2. PubMed PMID: 17208639.
23. 23. Thomas A, Rhoads A, Pinkerton E, Schroeder MC, Conway KM, Hundley WG, et al. Incidence and Survival Among Young Women With Stage I-III Breast Cancer: SEER 2000-2015. JNCI Cancer Spectr. 2019;3(3):pkz040. Epub 2019/08/09. doi: 10.1093/jncics/pkz040. PubMed PMID: 31392297; PubMed Central PMCID: PMCPMC6668585.
24. 24. Kim IK, Park S, Hwang H, Lee JS, Ko SM, Kim SI, et al. Clinical Significance of Age at the Time of Diagnosis among Young Breast Cancer Patients. Journal of breast cancer. 2011;14(4):314-21. Epub 2012/02/11. doi: 10.4048/jbc.2011.14.4.314. PubMed PMID: 22323919; PubMed Central PMCID: PMCPMC3268929.