Prognosis of very young breast cancer patients

Abstract

The relation between age of breast cancer patients at presentation and prognosis remains a matter of debate. Despite this controversy, more aggressive systemic treatments are claimed for younger patients. The population consisted of 1285 patients, which were divided in three age groups: (A) under the age of 35 (n = 63), (B) between 36 and 49 (448) and (C) older than 49 years (774). Clinical and pathological parameters, known to be related to prognosis, were recorded prospectively between 1983 and 1996 and related to the site of recurrence, disease free survival and survival. 41,27% of the patients from group A had recurrent disease compared to 25,7% for older patients (p=0,01). Confounding prognostic parameters were diameter, TNM-classification, location of the tumor within the breast, type of treatment and nodal status. However, these prognostic parameters did not explain why young patients did worse. The diameter of the tumor was even smaller with a mean of 2,49 cm within group A, compared to 2,74 and 3,21 cm for groups B and C respectively (p=0,001). Although the rate of locoregional relapse was identical in the three age groups, the younger age group had significantly more and earlier systemic recurrences (p=0,017). Overall survival was 73,53 (A), 84,65% (B) and 72,76 (C – p=0,004) at 5 years of follow-up. No prognostic parameter was significantly related to the risk of recurrence or survival. Younger breast cancer patients under the age of 35 have a significantly higher and earlier systemic recurrence compared to older age groups. This translates in a decreased survival 3 to 8 years after diagnosis. This poor prognosis can neither be explained nor predicted by routine clinical and pathological prognostic parameters