Abstract
BackgroundBreast cancer in young Saudi women is a crucial problem. According to the 2002 annual report of Saudi National Cancer Registry, breast cancers that developed before the age of 40 comprise 26.4% of all female breast cancers comparing to 6.5% in the USA. Breast cancer in young patients is often associated with a poorer prognosis, but there has been a scarcity of published data in the Middle East population.MethodsTotal of 867 breast cancer patients seen at King Faisal Specialist Hospital & Research Centre (KFSH&RC) between 1986 and 2002 were reviewed. Patients were divided in two age groups: ≤ 40 years and above 40 years. The clinicopathological characteristics and treatment outcomes were compared between younger and older age groups.ResultsMedian age at presentation was 45 years. A total of 288 (33.2%) patients were aged ≤ 40 years. Hormone receptors were positive in 69% of patients 40 and 78.2% of patients above 40 (p = 0.009). There was a significantly higher incidence of grade III tumor in younger patients compared to older patients (p = 0.0006). Stage, tumor size, lymphatic/vascular invasion, number of nodes and axillary lymph node status, did not differ significantly between the two age groups. Younger patients had a greater probability of recurrence at all time periods (p = 0.035). Young age had a negative impact on survival of patients with positive axillary lymph nodes (p = 0.030) but not on survival of patients with negative lymph nodes (p = 0.695). Stage, tumor size, nodal status and hormonal receptors had negative impact on survival. Adjuvant chemotherapy was administered to 87.9% of younger and 65.6% of older patients (p < 0.0001). In terms of hormone therapy, the proportion of tamoxifen treated patients was significantly lower in young age group (p < 0.0001). No significant difference in radiation therapy between the two groups.ConclusionYoung age (≤ 40) is an independent risk factor for relapse in operable Saudi breast cancer patients. The fundamental biology of young age breast cancer patients needs to be elucidated.
Highlights
Breast cancer in young Saudi women is a crucial problem
Invasive breast carcinoma occurring in young women generally has a higher proportion of pathological features associated with more aggressive disease (Higher proportion of late stage, positive nodes, high grade, extensive intraductal component, presence of lymphatic/vascular invasion, absence of estrogen receptor, amplification or over expression of Her2/neu gene, higher S-phase fraction) compared to breast carcinoma occurring in older patients [9,16,17,18,19,20,21]
The histology data showed that the distribution of invasive ductal carcinoma, compared to lobular carcinoma, was significantly higher in the younger age group compared to older age group (p = 0.0009)
Summary
According to the 2002 annual report of Saudi National Cancer Registry, breast cancers that developed before the age of 40 comprise 26.4% of all female breast cancers comparing to 6.5% in the USA. According to the 2002 annual report of Saudi national cancer registry, breast cancers that developed before the age 40 accounted for 26.4% of all female breast cancers compared with only 6.5% in USA [2]. There is a paucity of published literature on experiences of treating breast cancer in a young Middle East population. To this end, it is important for clinicians to clarify the existing controversy as to whether aggressive treatment for young women with breast cancer is justified
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