(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management

Publication
Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Although uncommon in women less than 40 years old, breast cancer in younger women may have unique biologic and treatment implications. The purpose of this study was to evaluate treatment of breast cancer in young women with respect to previously established clinical predictors of local therapy choice.

Thomas M. Churilla, MD, Christopher A. Peters, MD; Abington Memorial Hospital; The Commonwealth Medical College; Northeast Radiation Oncology Center

Background: Although uncommon in women less than 40 years old, breast cancer in younger women may have unique biologic and treatment implications. The purpose of this study was to evaluate treatment of breast cancer in young women with respect to previously established clinical predictors of local therapy choice.

Methods: The design of the study was a case-control analysis. Using the National Cancer Institute (NCI)-Surveillance, Epidemiology, and End Results (SEER) database, breast cancer cases from 2010 were queried and limited to women between the ages of 20–39 years (cases) and 60–64 years (controls), lobular/ductal histology, nonmetastatic disease, and treatment with surgery. Controls were established based on the median age of women diagnosed with breast cancer. First, we tested for associations between young age (ages 20–39 y) and tumor/demographic variables by calculating the odds ratio (OR) and computing Pearson’s chi-square value. Second, we tested for associations between young age and surgical procedure (breast-conserving surgery [BCS], simple mastectomy, modified radical mastectomy, and bilateral mastectomy). Third, in mastectomy patients, we tested for associations between young age and postmastectomy radiation therapy (PMRT). Finally, we constructed separate multiple logistic regression models for treatment choice (ie, surgery type and PMRT), adjusting for significant (P < .05) univariate relationships with young age (first analysis).

Results: A total of 7,115 patients were analyzed, with 1,518 (21.3%) representing women between the ages of 20–39. Compared with older women (ages 60–64), young women (ages 20–39) with breast cancer were more likely to have large, node-positive, estrogen receptor (ER)-negative tumors with ductal histology and be of minority race in multivariate analysis. Further, 63.2% of older women underwent BCS, whereas only 40.5 % of younger women underwent BCS. The OR of simple mastectomy was 1.30 (95% confidence interval [CI], 1.08–1.56), 2.07 for modified radical mastectomy (95% CI, 1.77–2.41), and 6.42 for bilateral prophylactic mastectomy (95% CI, 5.43–7.58) and significantly associated with young age relative to BCS. However, in multivariate analysis, only bilateral prophylactic mastectomy was significantly associated with young age (OR = 5.10; 95% CI, 4.24–6.13; P < .001). Finally, postmastectomy RT was more prevalent in young women (40.7%) compared with older women (23.1%), which retained significance in multivariate analysis (OR = 1.74; 95% CI, 1.42–2.14; P < .001).

Conclusions: In 2010, younger women with breast cancer were more likely to present with locally advanced, biologically aggressive malignancies. BCS was less common among young women, but this trend appears to be closely related to the tumor characteristics associated with young age and the prevalence of bilateral prophylactic mastectomy among young women. Postmastectomy RT was more frequently administered in young patients after adjustment for tumor and demographic variables.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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