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Improved survival in young women with breast cancer
B O Anderson1, R T Senie, J T Vetto
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Background:
Young age has been hypothesized to be an adverse prognostic factor for women with breast cancer. This association, based on historical data, may not reflect recent advances in breast cancer management.
Methods:
A retrospective study was conducted of all women age 30 or younger who underwent definitive operation at our institution for primary operable breast carcinoma during one of two consecutive 20-year periods (1950-1969 or 1970-1989). All cancers were restaged according to current staging criteria. Actuarial survival and recurrence-free survival rates from the two patient eras were compared with each other and with published statistics for older breast cancer patients.
Results:
Eligibility criteria were met by 81 women from the 1950-1969 era and 146 women from the 1970-1989 era. Histologic diagnoses, tumor sizes, incidence of axillary nodal metastases, number of positive nodes, and American Joint Committee on Cancer stage at presentation were similarly distributed in the two eras. Despite these similarities, improved survival (p = 0.009) was observed in the later era. Local recurrences were also more common (p < 0.05) in the later era in association with less extensive resections. These local recurrences had an adverse impact on recurrence-free survival in the later era, but no concomitant decrease in overall survival was observed. Node-positive patients who received chemotherapy demonstrated a trend toward improved survival (p = 0.06) compared with node-positive patients who did not. Survival for patients in the later era was similar to that for older women as reported in other published series.
Conclusions:
The stage of presentation of breast cancer in women 30 years or younger appears unchanged from prior decades, but survival has improved in association with the use of less extensive surgical resections and the introduction of cytotoxic chemotherapy. With current treatment, primary operable breast cancer in young women appears to have a similar prognosis to breast cancer in older women.