Breast cancer in young Asian women: study on survival

BACKGROUND: Breast cancer in young patients is often associated with a poorer prognosis, but there has been a paucity of published data in an Asian population. METHODS: One hundred and six patients (12.6%) under the age of 40 years with breast cancer (group V) were compared with 737 patients with breast cancer aged 40 years or more (group W). Demographics, presentations, pathological profiles, treatment and survival measures were analysed. RESULTS: Median tumour size was similar in both groups. Group V had more patients with grade 3 tumours and nodal involvement compared to group W (51.5% vs 38.1%, P = 0.012 and 52.5% vs 41.8%, P = 0.045). The mean Nottingham prognostic index (NPI) score was significantly higher in group V compared to group W (4.75 vs 4.26, P < 0.001). The incidences of chemotherapy and radiotherapy in group V were higher than group W (69.2% vs 35.2%, P < 0.001 and 41.1% vs 24.4%, P = 0.002). There were no differences in overall survival and disease-free survival (local recurrence). CONCLUSION: Patients below 40 years with breast cancer have tumours with a poorer prognostic profile. However, this did not translate into a poorer overall survival, and this might be attributable to more aggressive adjuvant treatment of younger patients.     

Evaluation of recurrence patterns and survival in modern series of young women with breast cancer

The data on oncologic outcomes in young women with breast cancer (BC) are dated as it relates to recurrences and mortality. Our goal was to assess these outcomes in a modern series of young women with BC. A retrospective chart review identified women ≤40 years old with stage I‐III BC diagnosed from 2006 to 2013 at our institution. Demographics, tumor biology, type of operation, recurrence, and survival were analyzed. Overall, 322 women were identified. Most had ER+(70%) infiltrating ductal tumors (88%) with low stage (42% T1; 41% T2; 56% N0). Follow‐up was 4.2 years with 5.6% local‐regional recurrence (LRR), 15.2% metastatic recurrence (MR), and 8% mortality. There was no survival difference based on demographics, tumor biology, or type of operation. T3 tumors (P < .001) and node positivity (P < .001) were associated with worse disease‐free survival. In this modern series of young women with BC, stage rather than tumor biology or surgical choice has more effect on recurrence‐free survival. MR was more common than LRR, with most MR occurring within the first 2 years after surgery.     

Breast cancer in young women: Pathologic features and molecular phenotype

PurposeControversy exists about the prognosis of breast cancer in young women. Our objective was to describe clinicopathological and prognostic features to improve adjuvant treatment indications.MethodsWe conducted a retrospective multi centre study including fifteen French hospitals. Disease-free survival's data, clinical and pathological criteria were collected.Results5815 patients were included, 15.6% of them where between 35 and 40 years old and 8.7% below 35. In 94% of the cases, a palpable masse was found in patients ≤35 years old. Triple negative and HER2 tumors were predominantly found in patients ≤35 (22.2% and 22.1%, p < 0.01). A young age ≤40 years (p < 0.001; hazard ratio [HR]: 2.05; 95% confidence limit [CL]: 1.60–2.63) or ≤35 years (p < 0.001; [HR]: 3.86; 95% [CL]: 2.69–5.53) impacted on the indication of chemotherapy. Age ≤35 (p < 0.001; [HR]: 2.01; 95% [CL]: 1.36–2.95) was a significantly negative factor on disease-free survival. Chemotherapy (p < 0.006; [HR]: 0.6; 95% [CL]: 0.40–0.86) and positive hormone receptor status (p < 0.001; [HR]: 0.6; 95% [CL]: 0.54–0.79) appeared to be protector factors. Patients under 36, had a significantly higher rate of local recurrence and distant metastasis compared to patients >35–40 (21.5 vs. 15.4% and 21.8 vs. 12.6%, p < 0.01).ConclusionYoung women present a different distribution of molecular phenotypes with more luminal B and triple negative tumors with a higher grade and more lymph node involvement. A young age, must be taken as a pejorative prognostic factor and must play a part in indication of adjuvant therapy.     

Breast reconstruction in women under 30: a 10-year experience

The number of women diagnosed with breast cancer at a young age (≤30years) continues to rise. As young women present for breast cancer management with greater frequency, an accurate characterization of the differences in cancer treatments and reconstruction techniques is imperative to optimize care. Here, we sought to identify the reconstruction trends in this population of women ≤30years at time of breast cancer diagnosis. We retrospectively reviewed the charts of women aged ≤30years who underwent breast reconstruction at The University of Texas M.D. Anderson Cancer Center. We extracted data on the patients' diagnosis, adjuvant therapy, reconstructive choice, reason for reconstructive choice, and decision for contralateral prophylactic mastectomy (CPM). Over a 10-year period, 54 patients aged ≤30years underwent 77 breast reconstructions, including 30 microsurgical autologous tissue reconstructions and 34 tissue expander-based reconstructions. Donor site limitations, including insufficient abdominal tissue, restricted the number of patients eligible for abdominal based reconstruction despite the patients' interest in the latter. The rate of CPM was 43%, which was significantly higher than the national average of 8%, further complicating the possibility of total autologous reconstruction. Because of the high rate of bilateral mastectomy and innate donor tissue limitations, young, healthy women who are otherwise ideal candidates for free tissue transfer using the abdominal donor site undergo significantly more tissue expander reconstructions than expected. Implant-based reconstruction or donor sites other than the abdomen must be considered in this unique population.     

Breast cancer in women under 50: Most are not high risk

Background

In 2009, the United States Preventive Services Task Force changed the recommended starting age for annual screening mammography from 40 to 50 for non-“high risk” women. In 2015, the American Cancer Society issued similar guidelines, with a starting age of 45. Our hypothesis is that most women diagnosed with breast cancer in this age group do not fall into a “high risk” category.

青年女性乳腺癌临床病理学特点及预后相关因素分析

目的 探讨青年女性乳腺癌临床病理学特征,分析临床治疗选择与预后的关系。方法 回顾性分析自2008年1月至2014年12月北京大学第一医院乳腺疾病中心经治的乳腺癌病例,比较同期青年组（<35岁）与年长组（≥35岁）的临床病理学差异,探讨青年女性乳腺癌临床病理学特征与预后之间的相关性,绘制Kaplan-Meier曲线计算生存期,通过Log-rank检验进行单因素分析,并行Cox模型多因素分析,应用后退法筛选影响生存的危险因素。结果 青年女性乳腺癌110例,占全部乳腺癌的5.7%,中位年龄32（21~34）岁,与同时期≥35岁病人相比较,两组Luminal A型、Luminal B型（HER2阴性）分布差异有统计学意义（P＜0.001）。青年女性乳腺癌临床分期、原位癌发病率、HR阳性及HER2阳性乳腺癌所占比例与≥35岁病人差异均无统计学意义。青年女性乳腺癌病人选择保乳手术、全乳房切除联合成形手术的比例与≥35岁病人差异具有统计学意义（P<0.001）。中位随访时间31.5（8~78）个月,5年存活率93.3%,5年无进展存活率89.3%。单因素及多因素分析显示,青年女性乳腺癌无进展生存期与N分期（P＜0.001）、M分期（P＜0.001）相关,总生存期与N分期相关（P＜0.001）。结论 青年女性乳腺癌具有独特的临床病理学特点,在强化内分泌治疗的同时应注意生育保护,由于对外形、生活质量要求更高,青年女性乳腺癌的外科手术方式需要个体化选择。     

Breast Carcinoma in Young Women: No Evidence of Increasing Rates of Metastatic Breast Carcinoma in a Single Tertiary Center Review

Breast carcinoma in young women aged less than 40 years attracts a high level of mainstream media coverage, and there is a gap between societal perceptions of the disease as a growing problem and epidemiological trends. Several population studies have reported that the overall incidence of breast carcinoma in young women is stable, while one recent article suggested that the relative proportion of breast carcinoma in young women that is metastatic at diagnosis is growing. We sought to establish whether these trends were apparent at our institution. In this study, the clinical database at a breast carcinoma tertiary center was reviewed in terms of clinicopathologic data on patient age, diagnosis, clinical and pathologic stage, hormone receptor status, and HER‐2 overexpression status for the period 2000–2011. Over the study period, young patients represented a decreasing proportion of all breast carcinoma cases (10.8% [2000–2003] to 8.7% [2008–2011]; p < 0.0001) treated at our institution. Young patients were more likely than patients aged 40 years or older to present with metastatic (M1) disease (5.4% versus 4.4%; p = 0.009), to be triple negative (21.6% versus 13%; p < 0.001), or to be HER‐2 positive (24.3% versus 14.8%; p < 0.01). Young patients with HER‐2‐positive cancers were significantly more likely to present with metastatic disease (8.3% versus 4.8%; p = 0.004). This study showed no demonstrable increase in the relative proportion of breast cancer occurring in patients aged <40 years over the 12‐year period 2000–2011 and no increase in the proportion of young patients presenting with metastatic disease.     

Breast cancer in young women: an overview

Despite dramatic advances in cancer research setting, breast cancer remains a major health problem and represents currently a top biomedical research priority. Worldwide, breast cancer is the most common cancer affecting women, and its incidence and mortality rates are expected to increase significantly the next years. Recently the researchers’ interest has been attracted by breast cancer arising in young women. Current evidence suggests that in women aged <45 years, breast cancer is unquestionably the leading cause of cancer-related deaths. This type of cancer seems to be highly heterogeneous and has potentially aggressive and complex biological features. However, management strategies, recommendations and options are not age based and the ‘complex’ biology of this type of cancer remains uncertain and unexplored. In this review, we summarize the latest scientific information on breast cancer arising in young women highlighting the heterogeneity and the complex nature of this type of cancer.     

Contemporary management of breast cancer during pregnancy and subsequent lactation in a multicenter cohort of young women with breast cancer

The incidence of breast cancer diagnosed during pregnancy is increasing. We sought to characterize patient, treatment, pregnancy and lactation factors among young women with newly diagnosed breast cancer during pregnancy in a prospective cohort study. We identified all women who were pregnant when diagnosed with invasive breast cancer among those enrolled in the Young Women's Breast Cancer Study (NCT01468246), and collected details on pregnancy, birth and lactation from surveys, and treatment information medical record review. Of 1302 enrolled participants, 976 women with invasive breast cancer completed full baseline surveys, among whom 39 (4.0%) patients reported being pregnant at diagnosis. Median age at diagnosis was 34 years (range: 25‐40), with stage distribution: I, 28%; II, 44%; III, 23%; and IV, 5%. 74% of patients (29/39) had grade 3 tumors, 59% (23/39) ER‐positive, and 31% (12/39) HER2‐positive disease. 23 (59%) had surgery during pregnancy, 4 (17%) during the first trimester. Among the women who had surgery during pregnancy, 61% (14/23) underwent lumpectomy, 35% (8/23) unilateral, and 4% (1/23) bilateral mastectomy. All patients who had chemotherapy (51%, 20/39) received it in second and third trimesters, and had ACx4. There were 31 live births, 2 spontaneous, and 5 therapeutic abortions. Among live births, 16 (41%) were before 37 weeks of gestation. Three women reported breastfeeding. Within 6 months after delivery, comprehensive staging in 13 patients showed upstaging in four patients. In a contemporary cohort of young women with breast cancer, pregnancy at diagnosis is relatively uncommon. Treatment during pregnancy can generally be consistent with standard surgical and chemotherapy approaches, with attention to timing of therapies. Longer‐term outcomes including effects of some timing issues including delayed use of anti‐HER2 therapy on patient outcomes warrant further research.     

Improved survival in young women with breast cancer

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.Results of this study were presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994, and was judged Best Clinical Paper in the Resident/Fellow Essay Contest.     

广西京族青年女性鼻外形的测量分析

目的：了解、积累广西京族青年女性鼻外形方面的体质人类学资料,为美容、整形外科学提供面部形态学基础理论。方法：按体质人类学测量要求,测量300例18～30岁发育正常的广西京族青年女性的鼻宽、鼻高、鼻长、鼻深等项目,并计算了鼻宽高指数、鼻深宽指数。结果：获得20项测量的正常值范围,对比广西壮族青年女性,以及临近的云南昆明地区的汉族青年女性的测量数据存在差异。结论：所得的有关数据、参数差异性对相关民族人种的临床美容、整形外科工作有指导意思。     

Breast cancer in young women: clinicopathological features and biological specificity

Literature data suggest that breast cancers occurring in young patients may be different from those arising in older women. In this study the clinicopathologic characteristics of 50 patients under 40 years of age were compared with those of patients aged over 60. Patients under 40 years old more frequently had a family history of breast cancer than did older patients (24% vs 17%) and had more often used oral contraceptives (29% vs 13%); on average they had experienced menarche 1 year earlier. For early onset breast carcinomas there was a higher frequency of grade 3 tumours (38% vs 17%) and oestrogen receptor negativity (46% vs 20%). In addition, in younger patients the carcinomas were mostly DNA aneuploid (78% vs 58%), with a higher proliferation rate (48% vs 26%) and more frequent c-erbB-2 overexpression (48% vs 26%) and p53 alteration (30% vs 8%). Our data demonstrate that breast cancers arising in young women have a significantly different biopathological profile from those in older patients, with a predominance of unfavourable prognostic parameters.     

年轻女性乳腺癌患者的影像学特点

目的观察年轻女性乳腺癌的临床病理特点及影像学表现。方法分析2007年12月—2008年12月经病理证实并具有完整临床资料的40例年轻女性乳腺癌患者(年龄≤35岁),均接受乳腺X线、超声检查。结果 41个病变,包括浸润性导管癌37个(其中伴广泛导管内癌7个),导管内癌1个,其他类型癌3个;其中23个病变(23/41,56.10%)伴淋巴结转移。对40个病灶进行受体检测,ER、PR阴性率分别为32.50%(13/40)、27.50%(11/40),Her-2阳性率为67.50%(27/40)。X线片显示27个病灶(27/41,65.85%)存在钙化;41个病灶中,18个(18/41,43.90%)表现为肿块伴钙化,9个(9/41,21.95%)单纯钙化,6个(6/41,14.63%)单纯肿块,4个结构扭曲(4/41,9.76%),4个病灶(4/41,9.76%,均见于致密型乳腺)影像学无异常表现。X线诊断敏感度为85.37%(35/41),超声诊断敏感度为100%(41/41)。结论钙化是年轻患者乳腺癌最常见的X线征象。对于有症状的年轻女性患者应首选超声检查,而X线有助于进一步观察病变特征。     

青年乳癌59例报告

目的 探讨青年乳癌临床诊断、治疗、预后的特点和影响预后的因素。方法 回顾性分析湘雅二医院院1990年1月－1998年12月59例青年女性乳癌的临床资料。结果 59例病人中，乳癌根治术31例，改良根治术25例，乳腺单纯切除术3例，腋窝淋巴结转移者34例（60.8%，34／56）。全组病人3年、5年和7年生存率分别为67.2%，61.0%和57.1%。腋窝淋巴结转移组3年、5年生存率（61.8%和45.5%）明显低于腋窝淋巴结阴性组（86.4%和83.3%）；C－erbB-2表达阴性组3，5年生存率（84.6%和82.4%）明显高于阳性表达组（54.6%和45.8%）。（均为P＜0.05）。结论 青年乳癌多为浸润性非特殊类型癌，腋窝淋巴结转移率高，预后差为特点；腋窝淋巴结状况、临床分期、病理类型、C-erbB-2表达是影响青年乳癌预后的重要因素。