Recurrence In Young Women Research Articles

Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours

Fear of cancer recurrence (FCR) is common and associated with younger age. This study aimed to explore the prevalence and correlates of FCR amongst younger survivors of early breast cancer. A total of 218 women aged 18-45 were diagnosed with stage 0-2 breast cancer at least 1 year earlier. The participants completed a web-based survey including a validated measure of FCR and items exploring medical surveillance practices and health care use. A total of 70% of participants reported clinical levels of FCR. Higher FCR was associated with higher frequency of unscheduled visits to the GP, higher frequency of breast self-examination and other forms of self-examination for cancer, not having mammograms or ultrasounds or other forms of cancer screening in the past year, more complementary therapy use and the use of counselling and support groups. Young women with breast cancer are particularly vulnerable to FCR. The present study provides preliminary evidence that FCR is associated with higher health costs and lower surveillance rates which may compromise health outcomes. Routine screening for FCR in follow-up care is recommended.

High Rate of Endometriosis Recurrence in Young Women

Objective To evaluate rate and determinants of long-term recurrence of endometriosis in a population of young women. Design Retrospective cohort study. Setting University tertiary care referral center for women with benign gynecologic diseases. Participants Young women undergoing first-line conservative surgery for endometriosis were eligible for the study. Data on age at surgery, disease stage, anatomical characteristics of endometriotic lesions, and endometriosis-related symptoms were collected. After diagnosis, patients were treated according to the standard care of the center. The protocol required all women to be followed up 1 month after surgery, and every 6 months afterward, with an interview to investigate persistence of symptoms, a clinical examination, and an ultrasound pelvic assessment. Results Fifty-seven women aged ≤ 21 (mean age at diagnosis ± SD: 19.0 ± 1.1 years) entered the study. During a 5-year follow-up, 32 (56%, 95% confidence interval [CI]: 43%-68%) recurrences of endometriosis were diagnosed. A second laparoscopy to treat the recurrence was performed in 11 (34%) cases and confirmed the presence of the disease in all of them. In the remaining 21 (66%) cases, the recurrence was based on the reappearance of the symptoms or clinical or sonographic findings. The recurrence rate increased constantly with time from first surgery. No association emerged between recurrence rate and endometriosis-related symptoms, site/stage of the disease, type of surgery, and post-surgical medical treatment. Conclusions The recurrence rate of endometriosis in young women appears higher than in older women. Since no determinants for recurrence have been detected among the factors examined, a profile of women at increased risk cannot be drawn.

On the paternal origin of trisomy 21 Down syndrome.

BackgroundDown syndrome (DS), characterized by an extra free chromosome 21 is the most common genetic cause for congenital malformations and learning disability. It is well known that the extra chromosome 21 originates from the mother in more than 90% of cases, the incidence increases with maternal age and there is a high recurrence in young women. In a previous report we have presented data to indicate that maternal trisomy 21 (T21) ovarian mosaicism might provide the major causative factor underlying these patterns of DS inheritance. One important outstanding question concerns the reason why the extra chromosome 21 in DS rarely originates from the father, i.e. in less than 10% of T21 DS cases. We here report data indicating that one reason for this parental sex difference is a very much lower degree of fetal testicular in comparison to ovarian T21 mosaicism.ResultsWe used fluorescence in situ hybridisation (FISH) with two chromosome 21-specific probes to determine the copy number of chromosome 21 in fetal testicular cell nuclei from four male fetuses, following termination of pregnancy for a non-medical/social reason at gestational age 14-19 weeks. The cells studied were selected on the basis of their morphology alone, pending immunological specification of the relevant cell types. We could not detect any indication of testicular T21 mosaicism in any of these four male fetuses, when analysing at least 2000 cells per case (range 2038-3971, total 11.842). This result is highly statistically significant (p < 0.001) in comparison to the average of 0.54% ovarian T21 mosaicism (range 0.20-0.88%) that we identified in eight female fetuses analysing a total of 12.634 cells, as documented in a previous report in this journal.ConclusionBased on these observations we suggest that there is a significant sex difference in degrees of fetal germ line T21 mosaicism. Thus, it would appear that most female fetuses are T21 ovarian mosaics, while in sharp contrast most male fetuses may be either very low grade T21 testicular mosaics or they may be non-mosaics. We further propose that this sex difference in germ line T21 mosaicism may explain the much less frequent paternal origin of T21 DS than maternal. The mechanisms underlying the DS cases, where the extra chromosome 21 does originate from the father, remains unknown and further studies in this respect are required.

On the origin of trisomy 21 Down syndrome

BackgroundDown syndrome, characterized by an extra chromosome 21 is the most common genetic cause for congenital malformations and learning disability. It is well known that the extra chromosome 21 most often originates from the mother, the incidence increases with maternal age, there may be aberrant maternal chromosome 21 recombination and there is a higher recurrence in young women. In spite of intensive efforts to understand the underlying reason(s) for these characteristics, the origin still remains unknown. We hypothesize that maternal trisomy 21 ovarian mosaicism might provide the major causative factor.ResultsWe used fluorescence in situ hybridization (FISH) with two chromosome 21-specific probes to determine the copy number of chromosome 21 in ovarian cells from eight female foetuses at gestational age 14–22 weeks. All eight phenotypically normal female foetuses were found to be mosaics, containing ovarian cells with an extra chromosome 21. Trisomy 21 occurred with about the same frequency in cells that had entered meiosis as in pre-meiotic and ovarian mesenchymal stroma cells.ConclusionWe suggest that most normal female foetuses are trisomy 21 ovarian mosaics and the maternal age effect is caused by differential selection of these cells during foetal and postnatal development until ovulation. The exceptional occurrence of high-grade ovarian mosaicism may explain why some women have a child with Down syndrome already at young age as well as the associated increased incidence at subsequent conceptions. We also propose that our findings may explain the aberrant maternal recombination patterns previously found by family linkage analysis.

929 poster The predictive value of lymphangiogenesis for local recurrence in young women treated by breast conserving surgery and radiotherapy

929 poster The predictive value of lymphangiogenesis for local recurrence in young women treated by breast conserving surgery and radiotherapy

The impact of obesity on outcomes in a population-based cohort of women with early-onset breast cancer

9540 Background: Obesity (defined by body mass index, BMI≥30kg/m2) has been associated with adverse outcomes in postmenopausal women with breast cancer (BC). In premenopausal women the relationship is less clear. The impact of obesity on disease recurrence and death was studied in the population-based Australian Breast Cancer Family Study (ABCFS). Methods: 1108 early-stage BC patients, 47% diagnosed age< 40, were followed prospectively. Details on weight and height were collected by face-to-face interview at recruitment to the ABCFS. BC treatment and outcome data were abstracted from medical records. Ideal dose of chemotherapy was calculated and compared to actual dose received at cycle 1. The hazard ratio (HR) for disease recurrence and death associated with obesity was estimated using Cox proportional hazard survival models adjusting for number of axillary nodes, age, tumor size, grade and ER/PR at diagnosis. Results: Median follow-up was 5(0.4–10.8) years. 133 were obese. 75%(817/1108) were premenopausal. Obesity was associated with increased tumor size (p=0.001), more involved axillary nodes (p=0.005) but not hormone receptor status. Multivariate analysis found that compared with those non-obese, obese women were more likely to develop both BC recurrence, HR 1.57(95% CI:1.11–2.22) or die HR 1.55(95%CI:1.01–2.39). In obese premenopausal women the HRs for disease recurrence and death were 1.50(95%CI:1.00–2.26) and 1.71(95%CI:1.05–2.77) respectively. No differences in prescribing patterns or underdosing of adjuvant chemotherapy were observed. Conclusions: A BMI ≥30kg/m2 is associated with poorer BC outcomes in both pre- and post-menopausal women. Other biological and hormonal factors apart from estrogen are probably responsible for this increased risk. Targeting obesity is a potential approach to reduce the risk of BC recurrence in young women. No significant financial relationships to disclose.

Factors associated with breast recurrence in young females treated with breast conservation therapy: how young is young?

Purpose/Objective: Many reports have found an association between young age and breast recurrence after breast conservation therapy, however few data and little consensus exists defining young age. The purpose of this study was to evaluate factors associated with breast recurrence in young women to better quantify and characterize which subsets may be at increased risk.