Breast cancer rarely occurs in young women. Our knowledge about disease presentation, prognosis and treatment effects are largely dependent upon older series.
Materials and methods
We evaluated biological features and stage at presentation for 1427 consecutive premenopausal patients aged ≤50 years with first diagnosis of invasive breast cancer referred to surgery at the European Institute of Oncology from April 1997 to August 2000. A total of 185 patients (13%) were aged <35 years (‘very young’) and 1242 (87%) were aged 35–50 years (‘less young’). The expression of estrogen receptors (ER), progesterone receptors (PgR), presence of vascular invasion (VI), grading (G), expression of Ki-67, HER2/neu overexpression, pathological stage according to TNM staging system (pTNM), pathological tumor size and number of axillary lymph node involvement were evaluated.
Results
Compared with less young patients, the very young patient group had a higher percentage of tumors classified as ER negative (P <0.001), PgR negative (P = 0.001), higher expression of Ki-67 ≥20% of cells stained; 62.2% versus 53%, (P <0.001), vascular or lymphatic invasion (48.6% versus 37.3%, P = 0.006), and pathological grade 3 (P <0.0001). There was no difference between the two groups for pT, pathological tumor size (pN) and number of positive lymph nodes.
Conclusions
We conclude that compared with less young premenopausal patients, very young women have a greater chance of having an endocrine-unresponsive tumor, and are more likely to present with a higher grade, more extensively proliferating and vessel invading disease. Pathological tumor size, nodal status and number of positive axillary lymph-nodes have a similar distribution among the younger and the older cohorts, thus not supporting previous data indicating more advanced disease in younger patients at diagnosis of operable disease.
