Abstract & Commentary
By William B. Ershler, MD, Director, Institute for Advanced Studies in Aging, Washington
Dr. Ershler is on the speaker’s bureau for Wyeth and does research for Ortho Biotech.
Synopsis: Breast cancer in young women is uncommon, but when it does occur, it is thought to be very aggressive. In this large series of young (< 35 years old) patients from a single institution seen over a 13-year period, high tumor grade, hormone receptor negativity, and family history of ovarian cancer turned out to be significant negative prognostic indicators.
Source: Gonzalez-Angulo AM, et al. Women age = or < 35 years with primary breast carcinoma. Cancer. 2005;103: 2466-2472.
Tumor registries and clinical trials that have included younger breast cancer patients have consistently demonstrated that younger patients (ie, those 35 years or younger) with breast cancer were more likely to have aggressive disease and less favorable outcomes.1,2 The current report details the initial presenting features of 452 breast cancer patients 35 years or younger (median age, 32 years) who were treated at The University of Texas M.D. Anderson Cancer Center (Houston, TX) between the years 1990 and 2002. Of these, one-third reported a family history of breast cancer and 5% a family history of ovarian cancer. Approximately 50% reported oral contraceptive use and 20% were obese.
Histologically, 69% of the tumors were Grade 3, 52% had positive estrogen receptors, and 48% had positive progesterone receptors. Her-2/neu status was available in 60% of tumor specimens and 34% were HER-2/neu positive.
Of the 452 patients, there were 185 disease recurrences and 84 deaths. Recurrence-free survival was significantly shorter in patients who had a family history of ovarian cancer (P < 0.0001) and in those who had hormone negative tumors (P =0.001). Overall survival was significantly shorter in patients who had a family history of ovarian cancer (P = 0.001), hormone receptor-negative tumors (P < 0.0001), or those with nuclear Grade 3 specimens (P = 0.005).
Commentary
Approximately 2% of breast cancers occur in patients younger than 35 years of age. The current retrospective review offers a focused analysis on various clinical features in patients of this age group. Tumor specimens were all processed at M.D. Anderson and all patients received 4-6 cycles of anthracycline-based chemotherapy. Overall 5-year survival was 77% and disease recurrence occurred more commonly in women with aggressive appearing histology and a family history of ovarian cancer.
The review, however, was disappointing in that no comparison was made with older breast cancer patients with regard to those same biological features (hormone receptor or Her2/neu status or tumor grade). It would seem that the numbers presented were not strikingly different from what might be expected for middle-aged or even older patients. In fact, it may well be that the tumors themselves are not very different, but that there is something about the youthful environment (endogenous hormonal milieu or availability of growth or angiogenesis factors) that favors more proliferative growth. The authors might be able to get a sense of this if, matched for tumor grade, stage and treatment, recurrence rates and overall survival turn out to be less favorable in the younger patients.
References
1. Merrill RM, et al. Cancer prevalence estimates based on tumour registry data in the Surveillance, Epidemiology, and End Results (SEER) Program. Int J Epidemiol. 2000;29:197-207.
2. Adami HO, et al. The relation between survival and age at diagnosis in breast cancer. N Engl J Med. 1986;315:559-563.
Breast cancer in young women is uncommon, but when it does occur, it is thought to be very aggressive. In this large series of young (< 35 years old) patients from a single institution seen over a 13-year period, high tumor grade, hormone receptor negativity, and family history of ovarian cancer turned out to be significant negative prognostic indicators.
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