PHOENIXBreast cancer patients age 40 and younger treated with
breast conservation and irradiation have a significantly increased
risk of breast recurrence and distant metastases, compared with older
patients, a large retrospective French study has shown.
The study included 1,425 premenopausal patients with unilateral
invasive clinical stage I or II breast cancer treated with breast-conserving
surgery and radiation therapy at the Institut Curie, Anne de la
Rochefordiere, MD, reported at the annual meeting of the American
Society of Therapeutic Radiology and Oncology.
Patients were stratified into three age groups: very young (35 or
less, 128 patients); intermediate age (36 to 40, 226 patients); and
older age (over 40, 1,071 patients). We observed no significant
differences among the three groups in terms of tumor size or clinical
nodal stage, Dr. de la Rochefordiere said.
At median follow-up of 10 years, 85% of patients older than 40 were
free from breast failure, compared with only 57% of patients 35 or
younger and 70% of patients age 36 to 40.
In addition, the younger patients were more likely to have early
breast recurrence. In all age groups, Dr. de la
Rochefordiere said, the annual hazard rate for breast failure
increased in the early years following primary treatment and
decreased subsequently. This early increase was significantly
higher in the two younger age groups.
When adjusted for other confounding variables, age was the only
independent prognostic factor for breast failure. The relative
risk of local relapse decreased by 8% for every increasing year of
age in the study population, that is, between 23 and 55 years,
she said. Factors found to have no impact on the risk of breast
failure included tumor size, margin status, vascular invasion, or the
use of adjuvant chemotherapy.
Similarly, using multivariate analysis, age was an independent
prognostic factor for the risk of distant metastases. At 10 years,
87% of patients older than 40 were free of metastatic disease,
compared with 69% and 64%, respectively, of the intermediate age and
very young patient groups. Patients under age 40 were also at
increased risk for distant metastases as a first event, but this was
significant only in the first 2 years after primary treatment.
Multivariate analysis also showed an association between early breast
recurrence (within 4 years of primary treatment) and a higher risk of
Finally, the researchers examined the adverse impact of young age on
outcome over time by assessing the odds ratios at 2-year intervals
from primary treatment. For this analysis, patients were regrouped
into two age groups: patients older than 40 and younger than 40.
The adverse impact of young age (age less than 40) on the
relative risk of breast failure lasted up to 4 years after primary
treatment and even up to 6 years, Dr. de la Rochefordiere said.
She noted that although mastectomy would probably decrease the rate
of local failure in these patients, it may not be the proper
answer to the poor prognosis of breast cancer in young patients. The
problem might be that young patients have a more aggressive
biology. Thus, she emphasized, significant effort should
be made to understand the biological patterns of breast cancer in
this age group in order to improve treatment selection and treatment efficacy.