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. 2021 Mar 15;109(4):1007-1018.
doi: 10.1016/j.ijrobp.2020.10.022. Epub 2020 Oct 24.

10-Year Breast Cancer Outcomes in Women ≤35 Years of Age

Cole Billena  1 , Molly Wilgucki  1 , Jessica Flynn  2 , Leslie Modlin  1 , Audree Tadros  3 , Pedram Razavi  4 , Lior Z Braunstein  1 , Erin Gillespie  1 , Oren Cahlon  1 , Beryl McCormick  1 , Zhigang Zhang  2 , Monica Morrow  3 , Simon Powell  1 , Atif J Khan  5
Affiliations

10-Year Breast Cancer Outcomes in Women ≤35 Years of Age

Cole Billena et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: Breast cancer diagnosis at a very young age has been independently correlated with worse outcomes. Appropriately intensifying treatment in these patients is warranted, even as we acknowledge the risks of potentially mutagenic adjuvant therapies. We examined local control, distant control, overall survival, and secondary malignancy rates by age cohort and by initial surgical strategy.

Methods and materials: Female patients less than or equal to 35 years of age diagnosed with invasive breast cancer from January 1, 1990, to December 31, 2010, were identified. Control groups of those aged 36 to 50 years (n = 6246) and 51 to 70 years (n = 7294) were delineated from an institutional registry. Clinicopathologic and follow-up information was collected. Chi-squared test was used to compare frequencies of categorical variables. Survival endpoints were evaluated using Kaplan-Meier methodology.

Results: A total of 529 patients ≤35 years of age met criteria for analysis. The median age of diagnosis was 32 years (range 20-35). Median follow-up was 10.3 years. On multivariable analysis, factors associated with overall survival (OS) were tumor size (hazard ratio [HR] 1.14, P = .02), presence of lymphovascular invasion (HR 2.2, P <.001), estrogen receptor positivity (HR 0.64, P = .015), receipt of adjuvant chemotherapy (HR 0.52, P = .035), and black race (HR 2.87, P <.001). The ultra-young were more likely to experience local failure compared with the aged 36 to 50 group (HR 2.2, 95% CI 1.8-2.6, P < .001) and aged 51 to 70 group (HR 3.1, 95% CI 2.45 - 3.9, P <.001). The cumulative incidence of secondary malignancies at 5 and 10 years was 2.2% and 4.4%, respectively. Receipt of radiation was not significantly associated with secondary malignancies or contralateral breast cancer.

Conclusion: Survival and recurrence outcomes in breast cancer patients ≤35 years are worse compared with those aged 36 to 50 or 51 to 70 years. Based on our data, breast conservation therapy is appropriate for these patients, and the concern for second malignancies should not impinge on the known indications for postoperative radiation therapy.

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Figures

Figure 1:
Figure 1:
Cumulative incidence of (a) locoregional recurrences and (b) distant metastasis in the three age groups. (c) Kaplan Meier survival curve for overall survival by age cohort.
Figure 2:
Figure 2:
Cumulative incidence of (a) locoregional recurrence and (b) distant metastases in the ≤35 age group stratified by upfront treatment approach.
Figure 3:
Figure 3:
Cumulative incidences of secondary malignancies (a) and contralateral breast cancers (b) stratified by receipt of RT.
See this image and copyright information in PMC

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