Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients

Hikmat Abdel-Razeq,Hanan Almasri,Fadwa Abdel Rahman,Sereen Iweir,Ayat Taqash,Rashid Abdel-Razeq,Rayan Bater,Hadeel Abdelkhaleq

doi:10.1038/s41598-021-93676-w

Hikmat Abdel-Razeq, Hanan Almasri + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-93676-w

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Abstract

In developing countries, breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. The study involved two cohorts; older patients (≥ 65 years, n = 553) and younger ones (≤ 40 years, n = 417). Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Compared to younger patients, older patients were more likely to present with advanced-stage disease (20.6% vs. 15.1%, p = .028). However, among those with non-metastatic disease, younger patients tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p < .001), T-3/4 (28.2% vs. 13.8%, p < .001) and HER2-positive disease (29.3% vs. 16.3%, p < .001). The 5-year overall survival (OS) rate was significantly better for the younger (72.1%) compared to the older (67.6%), p = .035. However, no significant difference was observed in disease-free survival (DFS) between the two groups.In conclusion, younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was not insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Highlights

In developing countries, breast cancer is diagnosed at a much younger age
A cross-sectional study conducted by King Hussein Cancer Center in Jordan in 2019, which is the primary cancer treatment center of the country, characterized the clinical features of all breast cancer (BC) patients older than or equal to 65 years and revealed that the older patients had a 67.6% overall survival rate, only nodal metastasis was significantly associated with their survival, and they were not treated aggressively, with less than a third receiving chemotherapy[12]
Among patients with non-metastatic disease (M0), younger patients were more likely to present with nodal metastasis (73.2% versus 55.6%, p < 0.001), gradeIII tumors (51.4% versus 38.7%, p < 0.001), lymphovascular invasion (48.6% vs 39.4%, p < 0.001), and more likely to have T-3 (22.3%) and T-4 (5.9%) disease than were the older patients at 10.9% and 2.9%, respectively, p < 0.001 (Fig. 1)

Summary

Introduction

Breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. Abbreviations BC Breast cancer DFS Disease-free survival ER Estrogen receptor HCP Healthcare provider HER2 Human epidermal growth factor receptor 2 ILC Invasive lobular carcinoma IRB Institutional review board M0 Cases without evidence of distal metastases M1 Cases with distal metastases MRM Modified radical mastectomy OS Overall survival PR Progesterone receptor SEER Surveillance, epidemiology, and end results medicare database SSM Skin-sparing mastectomy. In both developing and developed countries, breast cancer (BC) is the most common cancer in women and is the second most commonly diagnosed type of cancer overall. This study will provide a valuable update on the use of age as a prognostic factor for BC patients, given the large age gap between the two cohorts, as well as novel insight on a population develops the disease at an untypically younger age

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