Abstract
BackgroundBreast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. Less favorable prognosis and low survival were found.In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women.FindingsFour hundred and nine women aged 35 years or less were included in this study. All these women were diagnosed as having breast cancer at the National Institute of Oncology in Rabat, Morocco between 2003 and 2007. The relation between clinical and therapeutic characteristics and event-free survival (EFS) and overall survival (OS) were assessed by Cox regression analysis.The median age of the patients was 32 years. Fifty three patients (13%) have metastatic disease at diagnosis and 356 patients (87%) had localised disease. In 57.9% of the cases, the estrogen receptors status was positive. The median follow-up was 32.2 months. After 3 years the survival rate was 80.6%. In the case of localised disease, OS and EFS at 3 years were 83.2% and 62.5%, respectively. OS and EFS at 3 years was higher in patients with stage I than patients with stage II and stage III (p = 0.001). Positive estrogen receptors was significantly associated to OS and EFS at 3 years compared to negative estrogen receptors (p = 0.001). Adjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy were associated with net benefit in OS and EFS at 3 years. Cox regression analysis showed that negative ER was significantly associated with poorer OS (HR = 2.42, 95% CI = 1.25 - 4.66, p < 0.009) and poorer EFS (HR = 1.73, 95%CI = 1.05 - 2.86, p = 0.03). Stage III disease were associated to poorer EFS (HR = 5.35, 95%CI = 1.60 -17.84, p = 0.006).ConclusionsIn Morocco, young women with breast cancer had less favorable prognosis. Multivariate analysis showed that negative hormone receptor status was associated with lower EFS and OS. Clinical trials should be launched to improve the survival of these young women with breast cancer.
Highlights
Breast cancer is uncommon in young women and induces more aggressive biologic characteristics
Multivariate analysis showed that negative hormone receptor status was associated with lower event-free survival (EFS) and overall survival (OS)
Clinical trials should be launched to improve the survival of these young women with breast cancer
Summary
Breast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women. Breast cancer in young women is uncommon. 2% of patients with breast carcinoma are age ≤ 35 years old at the time of diagnosis [1,2]. Young patients with breast cancer had more aggressive clinical and biological characteristics, less. According to the 1998 St Gallen guidelines, age ≤ 35 was a poor prognostic factor and supported the use of more aggressive systemic therapy, including chemotherapy in all younger patients regardless of other factors [8]. Other particularities must be studied in this category of patients: fertility, menopause induced by treatment, self-image and sexuality
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