Young age: an independent risk factor for disease-free survival in women with operable breast cancer

Abstract

Background: The incidence of breast cancer in young women (age < 35) is low. The biology of the disease in this age group is poorly understood, and there are conflicting data regarding the prognosis for these women compared to older patients.

Methods: We retrospectively analyzed 2040 consecutive primary invasive breast cancer patients who underwent surgical procedures at our institution between 1990 and 1999. The younger age group was defined as patients aged <35 years at the time of diagnosis. The clinicopathological characteristics and treatment outcomes were compared between younger and older age groups.

Results: A total of 256 (12.5%) patients were aged <35. There was a significantly higher incidence of nuclear grade 3 and medullary histological-type tumors in younger patients compared to older patients. Axillary lymph node status, T stage, histological grade, c-erbB2 expression and estrogen receptor status did not differ significantly between the two age groups. Younger patients had a greater probability of recurrence and death at all time periods. Although there was no significant difference in disease-free survival between the two age groups in lymph node-negative patients, the younger group showed worse prognosis among lymph node-positive patients (p < 0.001). In multivariate analysis, young age remained a significant predictor of recurrence (p = 0.010).

Conclusion: Young age (<35) is an independent risk factor for relapse in operable breast cancer patients.

Figure 1

(A) Disease-free survival curves for women <35 vs. ≥ 35 years old. Patients younger than 35 had significantly worse outcomes than their older counterparts (p < 0.001). (B) Overall survival curves showing patients younger than 35 had significantly worse outcomes than their older counterparts (p = 0.002).

Figure 2

(A) Disease-free survival curves in axillary lymph node-negative patients showing no significant difference between the two age groups (p = 0.223). (B) Disease-free survival curves in axillary lymph node-positive patients showing patients younger than 35 had significantly worse outcomes than their older counterparts (p < 0.001).