Breast cancer in young women: prognostic factors and clinicopathological features

A young age at diagnosis of breast cancer as a negative prognostic factor is a controversial issue. Some reports indicate that breast cancer in young women has different clinicopathological characteristics than in the elderly, while others found no correlation between prognosis and age. The aim of the present study was to assess the clinicopathological characteristics and prognostic factors of breast cancer in young women compared with elderly patients.

Thirty-seven operable breast cancer patients below 40 years of age, treated with mastectomy or breast conserving treatment and radiation therapy with or without adjuvant chemotherapy and tamoxifen, were assessed clinically and pathologically. Tumor size, lymph node status, histological grade, mitotic index, presence of estrogen and progesterone receptors, c-erbB2 expression, p53 and the MIB-1 proliferation index were evaluated histopathologically and immunohistochemically. Prognostic factors were compared to those for breast cancer patients age 60 years and older, with special attention to recurrence, distant metastasis and five-year survival between two groups.

Breast cancer in young women showed a more aggressive phenotype than in elderly patients, with a larger tumor size, more lymph node involvement, and higher c-erbB2 and p53 expression, although the latter were usually limited to more advanced stages. A higher MIB-1 proliferation index than in the elderly group was also noted, despite higher positivity and ER and PR. While adjuvant chemotherapy, including tamoxifen treatment, was more common, recurrence, metastasis and death were still higher than in elderly patients.

Thus a young age is associated with a poor prognosis in Indonesia.