Tumors In Young Women Research Articles

Patient and tumor characteristics associated with increased mortality in young women (< or =40 years) with breast cancer.

The goal of the current study is to identify predictors responsible for mortality disparities between young (< or =40 years) and older (>40 years) women with breast cancer. From 1998 to 2006, 344 patients < or =40 years were treated for breast cancer. Cox regression models calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CI) to determine differences in breast cancer mortality in women < or =40 years versus >40 years (n = 3,252), controlling for potential confounders in univariate tests. From 1998 to 2006, 3,596 patients were treated for breast cancer; 9.6% were < or =40 years and 90.4% were >40 years. Young women were more likely to be African-American, with a family history of breast cancer, diagnosed at advanced stage, and treated by mastectomy (P < 0.05). Tumors in young women were more likely to be bilateral, T2/T3, grade III, ER/PR negative, and lymph-node positive (P < 0.01). Overall, young women (< or =40 years) with breast cancer were more likely to die compared with older women (>40 years) (aHR 1.52, CI 1.37-1.74). Young women (< or =40 years) with breast cancer are diagnosed at a more advanced stage and have tumors with poor prognostic features. Young women (< or =40 years) are 52% more likely to die from breast cancer compared to older women (>40 years).

Biology of breast cancers that present as interval cancers and at young age should inform how we approach early detection and prevention.

Abstract Abstract #6034 Population screening has increased the absolute number of breast cancer cases. In spite of widespread screening, there are still many patients who present with locally advanced breast cancer, often women who are young or who present with a mass between annual screens (“interval cancers”). Molecular profiling provides the opportunity to determine whether mammographically detected cancers are biologically distinct from locally advanced breast cancers. Methods: Tumor samples from the time of diagnosis (2002-2006), from patients with locally advanced breast cancers enrolled on the multi-site I-SPY TRIAL (CALGB 150007/150012 and ACRIN 6657) were compared to stage 1 &amp; 2 tumor samples collected in 2004 from multiple community Netherlands hospitals (RASTER dataset). The NKI 70 gene set was performed on 100 of 221 patients (80 more samples pending) from I-SPY and 228 of 242 patients from the RASTER dataset. The proportion of good vs. poor prognosis profiles were compared. Additionally, we have collected data on response to chemotherapy from the I-SPY patients. Finally, mammograms from the I-SPY and RASTER datasets are being reviewed to enable classification of tumors by presentation (palpable, screen detected, and interval cancer and negative prior mammogram within 1 year). Results: I-SPY data includes 221 patients with tumors ≥3cm in size; median tumor size is 6cm; 55% were &amp;lt;50 years old; 44% were ER negative. Only 20% had an NKI 70 gene good prognosis at time of diagnosis. The percentage of women under &amp;lt;40, 41-50, and &amp;gt;50, with a good prognosis is 10%, 23%, and 22%, respectively. The RASTER dataset included 427 patients from age 30 to 61. NKI 70 gene profiles are available in 219 patients: 66% were Stage 1; 33% were Stage 2. Overall, 51% had a NKI 70 gene good prognosis profile. For women under the age of 40, 31% had a NKI 70 gene poor prognosis. For women 40-50, and &amp;gt;50, the fraction of NKI 70 gene poor prognosis is 55% and 56%, respectively. Data will be presented based on mode of detection: screen vs. palpation (never screened vs. interval). Conclusion: The key observation is that the fraction of good prognosis tumors substantially increases with age. In patients too young for screening, the fraction of poor prognosis tumors is 69%. Patients who present with locally advanced breast cancers who are too young to be screened almost always have a poor prognosis signature. This may extend to those with interval cancers. This suggests that the tumors identified by screening, although they are early stage cancers, are not the precursors of the poor prognosis tumors in young women and those with locally advanced disease. Therefore, we may not be able to rely on current screening approaches to improve outcomes for young women and those with interval cancers. Further analysis will include reviewing interval cancer cases within the I-SPY dataset and assessing prognostic indicators. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6034.

Magnetic Resonance Imaging of Endometrial and Cervical Cancer

In this article we review the current and developing roles of magnetic resonance imaging (MRI) in endometrial and cervical cancer. In endometrial cancer, the purpose of MRI is to stage the primary tumor and in particular to identify myometrial and cervical invasion and extra-uterine disease, thereby informing preoperative surgical planning. MRI is also used to safely select young patients suitable for fertility-preserving medical management. In cervical cancer, MRI has an established role in local staging and in assessing proximal extension of tumors in young women for feasibility of fertility-preserving surgery. It is used to plan radiotherapy for primary tumors in cervical cancer and particularly for conformal radiotherapy to deliver optimal doses to the tumor sites, while limiting unwanted exposure of bowel and other pelvic organs. In both cancers, MRI is used for diagnosing nodal disease, surveillance, detection of recurrence, and evaluation of complications secondary to treatment.

Breast Cancer in Young Women: A New Color or a Different Shade of Pink?

Breast Cancer in Young Women: A New Color or a Different Shade of Pink?

Lifetime Physical Activity and Risk for Premenopausal Breast Cancer

Although only one quarter of breast malignancies occur before menopause, tumors in young women tend to be more aggressive than those in postmenopausal

Rare brain tumors in young women

Rare brain tumors in young women

Magnetic resonance imaging in gynaecological malignancies

In this article the current and developing roles of magnetic resonance imaging (MRI) in endometrial, cervical and ovarian cancer are reviewed. In endometrial cancer, MRI is used to identify myometrial invasion and extrauterine disease, allowing preoperative surgical planning in women with serious comorbidity. In cervical cancer, MRI has an established role in local staging. By assessing the proximal extension of tumours in young women, MRI determines the feasibility of fertility-preserving surgery. It is also used to plan and administer radiotherapy. This optimises tumour radiation, while limiting unwanted radiation to the bowel and other pelvic organs. In ovarian cancer, MRI is useful in young women as it is superior to ultrasound in diagnosing endometriomas, dermoids and fibroids, which can be misdiagnosed by ultrasound as malignant lesions.

Breast cancer in young women aged 35 or less

754 Background: Breast cancer (BC) in young women is often associated with aggressive tumor features and poor prognosis. The incidence of disease seems to increase. Therefore, a retrospective review was undertaken for pathological and biologic factors and the outcome was analyzed. Methods: 47 patients (pts) aged 35 and younger were treated for BC between 1994 and 2003. Mean age was 31,6. 24 pts received neoadjuvant, 22 pts adjuvant chemotherapy (CH). The adjuvant treatment was individual tailored. 6 pts received CMF. 23 pts were treated with anthracycline-based, 7 with taxane-based CH, 4 with a combination of both. 45 pts underwent radiation after CH. Tissue from tumorectomy was analyzed for ER, PgR, p53, Ki67, Her2-neu, EGRF, UPA and PAI1. Results: In 79% the initial tumor was more than 2cm. All pts with T3 and T4 tumors were treated with neoadjuvant CH. Nearly half of the pts (49%) presented with lymph node metastases. 81% of all tumors were invasive ductal. 60% were classified as grade 3. 67% of all tumors were ER+ and 53% PgR+. P53 was mutated in 42%(n=31), Her2neu positive in 55%(n=40), a high Ki67(>18%)(n=31)was found in 68%. EGRF status was negative in 80%(n=20), UPA was positive in 81%(n=21), PAI1 positive in 91%(n=21). 37 pts (79%) received breast conserving therapy (BCT), 6 combined with oncoplastic surgery. 6 pts (16%) with BCT suffered a local relapse, 1(10%) relapse seen with mastectomy. In 70% of pts without local relapse and BCT the tumor was 20mm or less. 65% of all pts have no metastases, 81,4% are still with no evidence of tumor, 83% are still alive. The mean follow-up is 44 months. Conclusions: More than 80% of the pts are still alive despite the aggressiveness and poor reputation of tumors in younger women. A higher rate of local relapses in pts with BCT could be seen, but smaller tumors seem to have a lower risk of recurrence. However, individual treatment adapted to each pt is necessary and important. No significant financial relationships to disclose.

Extrauterines Müllersches Adenosarkom bei einer 19-jährigen Patientin - Eine klinische Fallstudie

Wir berichten über eine 19-jährige Patientin mit dem seltenen Befund eines extrauterinen mesenchymalen Mischtumors. Der das gesamte kleine Becken ausfüllende und bis in den Oberbauch reichende 36 × 27 × 9 cm große Tumor mit einem Gewicht von 3160 g war subjektiv als rasche Bauchumfangszunahme aufgefallen. Intraoperativ zeigte sich ein vieltraubiger zystischer Tumor, der nur mit dem Fimbrienende der rechten Tube sowie kurzstreckig mit der rechten parietalen Bauchwand zusammenhing. Die histologische Untersuchung ergab den Befund eines Mischtumors unter dem Bild eines Adenofibroms, teilweise eines Müllerschen Adenosarkoms. Extrauterine mesenchymale Mischtumoren dieser Größe bei einer 19-jährigen Patientin sind eine Rarität. Wegen des sarkomatösen Anteils im Tumor haben wir unserer Patientin engmaschige gynäkologische Kontrolluntersuchungen empfohlen. Müllersche Adenosarkome zeigen im Allgemeinen einen niedrigen Malignitätsgrad mit geringem Rezidivrisiko.

Surgical management of desmoid tumors of the female pelvis

Background: Desmoid tumors are neoplasms characterized by proliferation of fibroblasts without cytologic features of malignancy. Although desmoid tumors are not uncommon, pelvic desmoid tumors are rare and therapeutically challenging. We describe the surgical management of seven patients with histologically confirmed desmoid tumors arising in the pelvis. Study Design: All patients, six with primary and one with recurrent desmoid tumors of the female pelvis, were treated at Mayo Clinic Rochester between 1976 and 1997. The mean age of one African-American and six Caucasian patients was 29.8 years (range 17 to 59 years). No history of previous relevant pelvic trauma was identified; six patients experienced pelvic or leg pain (or both). All patients presented with isolated masses; five of seven were located left of the midline, generally involving the obturator internis or levator muscles (or both). The surgical approach was transabdominal, with a vaginal component in one patient. In addition to this retrospective review of these seven patients, literature addressing the management of desmoid tumors of the female pelvis is reviewed. Results: Extirpative surgery necessitated resection of musculoskeletal, vascular, or adjacent soft tissue structures. Mean tumor diameter was 13.9 cm (range 5 to 27 cm). Although the median recorded blood loss was 1,425 mL, one patient who refused blood products died secondary to surgical hemorrhage. The median followup for the remaining evaluable patients was 57 months (range 13 to 249 months). Recurrent disease developed in 3 of 6 patients at 3, 11, and 13 months after surgical resection and was successfully managed with subsequent reoperations, with or without adjuvant radiotherapy. Conclusions: Although recent reports demonstrate selective regression of desmoid tumors with antiestrogen therapy, management of symptomatic pelvic desmoid tumors in young women may necessitate an operation. In our series, all primary and recurrent tumors were managed with resection of involved bone and other adjacent soft tissues. The role of adjunctive radiotherapy or hormonal therapy remains to be defined.

Photodynamic Therapy for the Hypercalcemic Type of the Small Cell Carcinoma of the Ovary in a Mouse Xenograft Model

Objective. The hypercalcemic type of the small cell carcinoma of the ovary (HTSCCO) is a rapidly fatal ovarian tumor in young women. Photodynamic therapy (PDT) induces selective necrosis to malignant tissues. The aim of this study was to determine the sensitivity of the HTSCCO to PDT in a mouse xenograft model.Methods. Tumors were obtained from a patient with a HTSCCO and were transplanted into nude mice. Following photosensitization with m-THPC, either superficial or interstitial laser light was administered to the tumors. Necroses were measured by morphometry. Serum calcium levels were determined prior to and after PDT.Results. Superficial irradiation of m-THPC sensitized tumors showed over three times more necrosis than control tumors (P = 0.037). Interstitially irradiated tumors showed over seven times more necrosis than control tumors (P = 0.0012). All animals showed a highly significant hypercalcemia prior to PDT (P < 0.0001). PDT induced a significant decrease in serum calcium levels (P = 0.0297).Conclusion. This study suggests that PDT may be of therapeutic value for the HTSCCO.

Diethylstilbestrol and adenocarcinoma of the vagina

In the latter 1960s, 7 young women with vaginal cancers were treated in New England, primarily at the Massachusetts General Hospital. They were unique because of their young age (15-22 years) and the histologic characteristics of these vaginal tumors (clear cell adenocarcinomas). Dr Robert E. Scully and 11 published a clinicopathologic study of these tumors, and at that time their association with prenatal exposure to diethylstilbestrol (DES) was not known. We were aware, however, that the 7 cases exceeded the total number of these rare tumors in young women that could be identified in the world literature up to that time. These patients had been treated by the senior gynecologists at the Massachusetts General Hospital, Drs Howard Ulfelder (Chairman of Gynecology), Francis Ingersoll, and Thomas Green. As a junior facultymember, I also had been involved in their care. The mother of one of the patients related to Dr Ulfelder her concern that her prenatal care had included ingestion of DES, and she believed this may have been responsible for her daughter's tumor. A case-control epidemiologic study was planned to investigate the sudden occurrence of a cluster of these rare tumors in the Boston area. Dr David C. Poskanzer, a neurologist, was recruited because of his epidemiologic training, and Dr T.C. Colton, of the Harvard School of Public Health, was also consulted for his advice in the statistical design of the epidemiologic investigation. By the time the study had begun, there was an eighth patient who had also been treated elsewhere in Boston. We selected as controls for each patient 4 daughters from the birth records of New England hospitals in which the 8 patients had been born. A comprehensive epidemiologic questionnaire was designed to investigate the maternal, paternal, and patient health histories of the 8 subjects and 32 control subjects. During the course of the administrat ion of the questionnaire, another mother from the original 7 patients, whose daughter had died of the tumor, spontaneously reported that she ...had taken DES during pregnancy and felt certain it was the cause of her daughter's cancer. The results of this study, which were published in the New England Journal of Medicine in 1971,2 showed that 7 of the 8 mothers of the daughters with cancer had taken DES for the treatment

R-217. Usefulness of a newly developed gasless method of laparoscopic surgery for ovarian tumours in young women

R-217. Usefulness of a newly developed gasless method of laparoscopic surgery for ovarian tumours in young women

Screening Examination of Breast Cancer: Review of the Recommended Guidelines

Background: Delays in breast cancer diagnosis may occur in young women due to a low index of suspicion. The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest a reasonable guideline for breast cancer screening examination. Materials and Methods: Among 820 patients, 102 patients were under 35 years and 122 patients were above 60 years of age. We reviewed medical records, mammograms and/or ultrasonography of 49 patients under 35 years and 48 patients above 60 years of age with pathologically-proven breast cancer. Pathological reports were as follows Invasive ductal carcinoma(IDC) was present 61.2% of patients in the young age group and ductal carcinoma in situ(DCIS) in 16.3%. IDC was present in 66.6% of the patients in the old age group, and DCIS in 8.33%. We analyzed mammography and ultrasonography to evaluate their usefulness in detecting breast cancer in patients under 35 years and over 60 years of age. Results: The mammographic results are as follows : 1) detection rate of lesion: 83.8%(under 35yrs), 100%(over 60yrs) 2) sensitivity of cancer: 67.6%(under 35yrs), 91.2%(over 60yrs) The ultrasonographic results are as follows : 1) detection rate of lesion: 100% 2) sensitivity of cancer: 87.2%(under 35yrs), 96.7%(over 60yrs) The breast cancer detection rate in women under 35 years old was comparable to that of women above 60 years old in our study. Conclusion: A striking histologic finding in the two groups was a higher incidence of nuclear Grade II and III tumors. This finding correlates with the reported increased incidence of high grade tumors in young women and may correlate with the poorer prognosis of breast cancer in young patients. We conclude that early screening examination is helpful for early detection of breast cancer in women under age 35.

Cervical cancer in older women: A molecular analysis of human papillomavirus types, HLA types, and p53 mutations

OBJECTIVE: The purpose of this study was to evaluate cervical cancers in older women to determine whether they differed from tumors in younger women with respect to human papillomavirus types, frequencies of p53 mutations, and presence of a proposed high-risk HLA-DR2 haplotype. STUDY DESIGN: Cervical tissue was obtained from women undergoing surgical treatment of in situ or invasive carcinoma of the cervix. Viral and genomic deoxyribonucleic acid was extracted. The presence of human papillomavirus deoxyribonucleic acid was detected by polymerase chain reaction amplification. Viral subtypes were assigned by means of a combination of type-specific amplification and automated sequencing of the L1 region. The presence of p53 mutations was evaluated by direct sequencing of exons 5 through 9. The HLA-DR locus was screened for the presence of the high-risk DRB1*1501 allele by means of selective polymerase chain reaction amplification followed by agarose gel electrophoresis of HLA-DR2 types. RESULTS: Tumors from 39 women 62 to 85 years old were analyzed. Tumors from 104 younger women formed a reference group. Human papillomavirus 16 was found in 41% and 54% and human papillomavirus 18 was found in 10% and 12% of the tissue samples from older and younger women, respectively. The overall distributions of human papillomavirus types did not differ statistically between the groups. One of the 25 older patients tested had a p53 mutation. This tumor also had a positive test result for human papillomavirus 18. The DR*1501 allele was present in 33% of the older patients and 28% of the younger patients. The expected frequency of this allele in white Americans is 19.8%. The increased frequency of this allele among both older and younger women with cervical cancer was statistically significant ( P < .05). CONCLUSIONS: We hypothesized that cervical cancer in older women might differ from that in younger women with respect to human papillomavirus types, natural host immunity, or the frequency of nonviral origins of the cancer. The findings show, however, that tumors from older women are extremely similar to those from younger women with respect to the human papillomavirus types present and the infrequent occurrence of p53 mutations. In addition we found that an HLA-DR allele that is associated with a risk of cervical cancer in younger women is also associated with risk in older women. These findings are most consistent with a model similar to that in younger women but with an unusually long latency for the transforming effect of the virus in some hosts. (Am J Obstet Gynecol 1998;179:56-61.)

Ovarian metastasis of extragenital tumors at the Zurich University Gynecologic Clinic 1978-1990

37 cases of extragenital tumours metastatic to the ovaries are analysed from a clinicopathological viewpoint. In 25 out of 334 patients who were operated on between 1978 and 1990 because of a palpable malignant ovarian tumour, ovarian involvement from extragenital cancer was diagnosed. The most frequent primary sites were the stomach (n = 7), colon (n = 6) and breast (n = 6). 4 of the 6 patients with metastatic colon carcinoma had previously documented diagnosis of colon cancer with a time interval between diagnosis of primary tumours and secondary ovarian tumour ranging up to 11 years. Only one patient had a previously known stomach cancer, operated on 32 months earlier. All our patients with gastrointestinal primary tumour died within 1 year (gastric origin) of detection of metastases and 2 years (colon carcinoma) except for one patient with metastasis of colon carcinoma, who is still living after more than 4 years and one patient with gastric carcinoma who survived 34 months after oophorectomy. Surprisingly, ovarian metastases of breast cancer were detected before the primary tumour in 2 out of 6 cases. The other 4 patients were operated on because of an ovarian tumour but had a known and previously operated breast cancer. 27 patients had therapeutic ovarian ablation in metastatic breast cancer without a palpable pelvic mass. None of these patients had symptoms related to the ovaries. In 12 (40%) patients we found microscopic metastases which were bilateral in 9 cases. Metastases to the ovary may not infrequently mimic primary ovarian tumour and are difficult to diagnose preoperatively. We hope that some clinical features described by us (nationality, patient's history, bilateral ovarian tumours in young women) will alert the clinician to investigate further in order to achieve the best possible therapeutic management, because some patients may benefit from adequate treatment and survive for a long time.

Epithelial Ovarian Tumors in Young Women Under 35 Years

The aim of this study was to investigate the clinical-pathological pattern of primary malignant epithelial ovarian tumors in women under 35 years old. We have retrospectively analyzed data from 545 patients with these tumors, identifying 49 patients under age 35. We found a higher frequency of borderline tumors and early-stage tumors in young women than in those over 35. The influence of age as a factor in survival was evaluated by comparing the outcome in young patients and in women over 35. The 5-year survival rate, according to stage and aggressiveness factors, was significantly better in young patients. These findings support the concept of a preclinical phase of epithelial carcinoma and show that young women may be selected for conservative surgery, allowing a good quality of life.

SUBLOCALIZATION OF SMALLEST COMMON REGIONS OF DELETION ON CHROMOSOME 17Q12-Q23 IN SPORADIC PRIMARY BREAST-TUMORS

Frequent loss of heterozygosity (LOH) on the long arm of chromosome 17 has been described in breast tumor DNAs by a number of groups, and recent fine genetic mapping and cloning of an inherited breast-ovarian cancer susceptibility locus (BRCA1) to a small region of 17q12-q21 has focused interest on this area. The absence of sporadic mutations in the BRCA1 gene in breast tumors studied so far suggests that there may be other tumor suppressor genes in the region involved in sporadic breast cancer. We studied 28 sporadic breast cancers with 14 highly polymorphic markers on chromosome 17 (2 on 17p and 12 on 17q). Most of the 17q markers are located within the 17q12-q23 region. We confirmed that 50% of tumors have deletions of at least one locus on chromosome arm 17q, and that half the deleted cases probably correspond to monosomies 17 or 17q. The other half correspond to a partial deletion on 17q and were used to identify 2 smallest common deleted regions (SCDR1 and SCDR2) on 17q12-q23. SCDR1 comprised the THRA1 gene, but not the 2 flanking loci tested (D17S250 and D17S800); while SCDR2 was defined by loci GIP and GH. BRCA1 was deleted in half the cases but it is outside the SCDR1. Moreover, breast tumors in young women frequently showed chromosome 17 alterations.

Adenofibrom und Adenosarkom des Uterus bei jungen Frauen

We report on two similar cases of young women with irregular menstrual bleeding. Curettage and biopsy revealed an adenofibroma of the uterus in case 1 (31 yrs) and an uterine adenosarcoma in case 2 (30 yrs). Hysterectomy was subsequently performed in both patients: histological examination of the hysterectomy specimen showed no remnants of the tumour in case 1. There was adenosarcoma tissue in the uterine cavity of case 2 but no myometrial infiltration. The difficulties of differential diagnosis of uterine soft tissue tumours in young women are discussed and the literature is reviewed.

Borderline and invasive epithelial ovarian tumors in young women

To review the occurrence, morbidity, and mortality of borderline and invasive epithelial ovarian tumors in young women.We conducted a 15-year retrospective review of the case records of the Women's Cancer Center, University of Minnesota, and the JL McKelvey Tumor Registry.We identified 67 patients under age 40 with borderline or invasive epithelial ovarian tumors. Fifty patients (75%) had borderline tumors and 17 (25%) had invasive tumors. The mean age at presentation was 31 years (range 14-39) for the borderline group and 34 years (range 23-39) for the invasive group. Pelvic pain and a palpable mass, present for less than 6 months, were the predominant presenting symptom and sign. There was no difference in the age at menarche between the patients with borderline (mean 12 years) and invasive tumors (mean 13 years). Fifty-seven patients were optimally cytoreduced to less than 2.0 cm after primary surgery. Thirty-five patients underwent second-look laparotomy, 15 of which were positive for tumor. A minority of patients in both groups had stage I tumors (17 in the borderline and one in the invasive group). Among patients with borderline tumors, there was no difference between "very young" and "young" patients in the stage at presentation or outcome. Similar proportions of patients presented with early- and late-stage disease. Three very young women (14%) and five young women (17%) have died. Among patients with invasive tumors, no difference existed between young and very young patients for stage at presentation, whereas grade and outcome differed significantly between the age groups (P < .05). Very young patients were more likely to present with grade 1 lesions, whereas patients aged 30-40 years were more likely to have grade 2 or 3 tumors (P < .05). Three (100%) of the very young patients have died, whereas seven (50%) of the young patients aged 30-40 years have died. The median survival of patients with borderline tumors was 36 months (range 2.0-150.5), significantly different from those with invasive tumors, whose median survival was 21 months (range 2.9-89.7) (P < .001).Borderline and invasive epithelial ovarian tumors are encountered in young women. Despite the implication of the term "borderline," such tumors are associated with considerable morbidity and mortality.