Comparison of the Characteristics and Prognosis Between Very Young Women and Older Women With Breast Cancer: A Multi-Institutional Report From China.

Liang Jin,Hao Pi,Shiyu Shen,Hengyu Li,Yaping Yang,Weidong Wei,Jieqiong Liu,Haiyan He,Zhiqin Liu,Mengna Wei

doi:10.3389/fonc.2022.783487

Abstract

PurposeOur understanding of breast cancer in very young women (≤35 years old) remains limited. We aimed to assess the clinicopathological characteristics, molecular subtype, and treatment distribution and prognosis of these young patients compared with patients over 35 years.MethodsWe retrospectively analyzed non-metastatic female breast cancer cases treated at three Chinese academic hospitals between January 1, 2008, and December 31, 2018. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between different age groups and stratified with distinct molecular subtypes.ResultsA total of 11,671 women were eligible for the final analyses, and 1,207 women (10.3%) were ≤35 years at disease onset. Very young breast cancer women were more likely to be single or childless, have higher-grade disease, have more probability of lymphovascular invasion (LVI) in tumor and triple-negative subtype, and be treated by lumpectomy, chemotherapy especially more anthracycline- and paclitaxel-based chemotherapy, endocrine therapy plus ovarian function suppression (OFS), anti-HER2 therapy, and/or radiotherapy than older women (P < 0.05 for all). Very young women had the lowest 5-year LRFS and DFS among all age groups (P < 0.001 for all). When stratified by molecular subtype, very young women had the worst outcomes vs. women from the 35~50-year-old group or those from >50-year-old group for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) subtype, including LRFS, DFS, and OS (P < 0.05 for all). In terms of LRFS and DFS, multivariate analyses showed similar results among the different age groups.ConclusionOur study demonstrated that very young women with breast cancer had higher-grade tumors, more probability of LVI in tumor, and more triple-negative subtype, when compared with older patients. They had less favorable survival outcomes, especially for patients with the HR+/HER2− subtype.

Highlights

The incidence of breast carcinoma in China is lower compared with that in European countries or America, yet, the newly diagnosed breast cancer cases have been increasing in China, in urban areas [1, 2]
Our study aimed to explore the distribution of clinicopathological features, Abbreviations: Local recurrence-free survival (LRFS), local recurrence-free survival; Disease-free survival (DFS), disease-free survival; Overall survival (OS), overall survival; SEER, Surveillance Epidemiology and End Results database; AJCC, American Joint Committee on Cancer Staging Manual; TNM, tumor– node–metastasis stage; HR+, hormone receptor positive; HR−, hormone receptor negative; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; EUSOMA, European Society of Breast Cancer Specialists; OFS, ovarian function suppression; LVI, lymphovascular invasion; IDC, invasive ductal carcinoma; DCIS, ductal carcinoma in situ; ILC, invasive lobular carcinoma; AI, aromatase inhibitor; TAM, tamoxifen; BCS, breast-conserving surgery; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection; 95% CI, 95% confidence interval
This study demonstrated that very young women with breast cancer had more higher-grade tumors, more probability of LVI in tumor, and more triple-negative subtype and received more lumpectomy, more chemotherapy especially more anthracycline- and paclitaxel-based chemotherapy, and more endocrine therapy plus OFS, anti-HER2 therapy, and adjuvant radiotherapy when compared with older patients

Summary

Introduction

The incidence of breast carcinoma in China is lower compared with that in European countries or America, yet, the newly diagnosed breast cancer cases have been increasing in China, in urban areas [1, 2]. A report from the Chinese Cancer Center showed that China had 3.8 million new patients with malignant tumor in 2014, including new 1.69 million female malignant tumor patients, in which the number of newly diagnosed breast cancer accounted for 16.51% [4]. Prior studies showed that young breast cancer patients were more likely to have adverse tumor characteristics (for instance, higher grade, higher fraction in tumor proliferation, higher probability in lymph vascular invasion, and hormone receptor negative) and worse prognosis than older patients [7–10]. Among these women, there is a special group of patients who have been diagnosed at a very young age (≤35 years old).

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