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Comparison between Early and Late Onset Breast Cancer in Pakistani Women Undergoing Breast Conservative Therapy: is There any Difference?

  • Bhatti, Abu Bakar Hafeez (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre) ;
  • Jamshed, Aarif (Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre) ;
  • Khan, Amina (Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre) ;
  • Siddiqui, Neelam (Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre) ;
  • Muzaffar, Nargis (Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre) ;
  • Shah, Mazhar Ali (Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre)
  • 발행 : 2014.07.15

초록

Background: Early onset breast cancer is associated with poor outcomes but variable results have been reported. It is a significant problem in Pakistani women but remains under reported. Breast conservation plays an important role in surgical management of this younger patient group. The objective of this study was to determine the outcome of breast conservative therapy in patients with early onset breast cancer in our population and compare it with their older counterparts. Materials and Methods: A review of patients with invasive breast cancer who underwent breast conservation surgery at Shaukat Khanum Cancer Hospital from 1997 to 2009 was performed. Patients were divided into two groups i.e. Group I age ${\leq}40$ and Group II >40 years. A total of 401 patients with breast cancer were identified in Group I and 405 patients in Group II. Demographics, histopathological findings and receptor status of the two groups were compared. The Chi square test was used for categorical variables. Outcome was assessed on basis of 10 year locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS). For survival analysis Kaplan Meier curves were used and significance was determined using the Log rank test. Cox regression was applied for multivariate analysis. Results: Median follow up was 4.31 (0.1-15.5) years. Median age at presentation was 34.6 years (17-40) and 51.9 years (41-82) for the two groups. Groups were significantly different from each other with respect to grade, receptor status, tumor stage and use of neoadjuvant therapy. No significant difference was present between the two groups for estimated 10 year LRRFS (86% vs 95%) (p=0.1), DFS (70% vs 70%) (p=0.5) and OS (75% vs 63%) (p=0.1). On multivariate analysis, tumor stage was an independent predictor of LRRFS, DFS and OS. Conclusions: Early onset breast cancer is associated with a distinct biology but does not lead to poorer outcomes in our population.

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참고문헌

  1. Adami HO, Malker B, Holmberg L, Persson I, Stone B (1986). The relation between survival and age at diagnosis in breast cancer. N Engl J Med, 315, 559-63. https://doi.org/10.1056/NEJM198608283150906
  2. Anderson BO, Senie RT, Vetto JT, et al (1995). Improved Survival in Young-Women with Breast-Cancer. Ann Sur Oncol, 2, 407-15. https://doi.org/10.1007/BF02306373
  3. Aebi S, Gelber S, Castiglione-Gertsch M, et al (2000). Is chemotherapy alone adequate for young women with oestrogen-receptor-positive breast cancer? Lancet, 355, 1869-74. https://doi.org/10.1016/S0140-6736(00)02292-3
  4. Anders CK, Hsu DS, Broadwater G, et al (2008). Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 26, 3324-30. https://doi.org/10.1200/JCO.2007.14.2471
  5. Anders CK, Johnson R, Litton J, Phillips M, Bleyer A (2009). Breast cancer before age 40 years. Semin Oncol, 36, 237-49. https://doi.org/10.1053/j.seminoncol.2009.03.001
  6. Bantema-Joppe EJ, de Munck L, Visser O, et al (2011). Early-stage young breast cancer patients: impact of local treatment on survival. Int J Radiat Oncol Biol Phys, 81, 553-9.
  7. Bollet MA, Sigal-Zafrani B, Mazeau V, et al (2007). Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first. Radiother Oncol, 82, 272-80. https://doi.org/10.1016/j.radonc.2007.01.001
  8. Bharat A, Aft RL, Gao F, Margenthaler JA (2009). Patient and tumor characteristics associated with increased mortality in young women (<= 40 years) with breast cancer. J Surg Oncol, 100, 248-51. https://doi.org/10.1002/jso.21268
  9. Chung M, Chang HR, Bland KI, Wanebo HJ (1996). Younger women with breast carcinoma have a poorer prognosis than older women. Cancer, 77, 97-103. https://doi.org/10.1002/(SICI)1097-0142(19960101)77:1<97::AID-CNCR16>3.0.CO;2-3
  10. Colleoni M, Rotmensz N, Robertson C, et al (2002). Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol, 13, 273-9.
  11. Chia KS, Du WB, Sankaranarayanan R, et al (2004). Do younger female breast cancer patients have a poorer prognosis? Results from a population-based survival analysis. Int J Cancer, 108, 761-5. https://doi.org/10.1002/ijc.11632
  12. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet, 365, 1687-717. https://doi.org/10.1016/S0140-6736(05)66544-0
  13. Elkum N, Dermime S, Ajarim D, et al (2007). Being 40 or younger is an independent risk factor for relapse in operable breast cancer patients: the Saudi Arabia experience. BMC Cancer, 7, 222. https://doi.org/10.1186/1471-2407-7-222
  14. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, et al (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 347, 1233-41. https://doi.org/10.1056/NEJMoa022152
  15. Foxcroft LM, Evans EB, Porter AJ (2004). The diagnosis of breast cancer in women younger than 40. Breast, 13, 297-306. https://doi.org/10.1016/j.breast.2004.02.012
  16. Gnerlich JL, Deshpande AD, Jeffe DB, et al (2009). Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg, 3, 341-7.
  17. Gabriel CA, Domchek SM (2010). Breast cancer in young women. Breast Cancer Res, 12, 212. https://doi.org/10.1186/bcr2647
  18. Kroman N, Holtveg H, Wohlfahrt J, et al (2004). Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer, 100, 688-93. https://doi.org/10.1002/cncr.20022
  19. Kim KJ, Huh SJ, Yang JH, et al (2005). Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol, 35, 126-33. https://doi.org/10.1093/jjco/hyi039
  20. Kimura M, Yanagita Y, Fujisawa T, et al (2007). Study of time course changes in annual recurrence rate for breast cancer. Data analysis of 2209 patients for 10 years post surgery. Breast Cancer Res Treat, 106, 407-11. https://doi.org/10.1007/s10549-007-9510-2
  21. Kwong A, Cheung P, Chan S, Lau S (2008). Breast cancer in Chinese women younger than age 40: are they different from their older counterparts? World J Surg, 32, 2554-61. https://doi.org/10.1007/s00268-008-9589-6
  22. Kheirelseid EH, Boggs JM, Curran C, et al (2011). Younger age as a prognostic indicator in breast cancer: a cohort study. BMC Cancer, 11, 383. https://doi.org/10.1186/1471-2407-11-383
  23. Khokher S, Qureshi MU, Riaz M, Akhtar N, Saleem A (2012). Clinicopathologic profile of breast cancer patients in Pakistan: ten years data of a local cancer hospital. Asian Pac J Cancer Prev, 13, 693-8. https://doi.org/10.7314/APJCP.2012.13.2.693
  24. Keramatinia A, Mousavi-Jarrahi SH, Hiteh M, Mosavi-Jarrahi A (2014). Trends in incidence of breast cancer among women under 40 in Asia. Asian Pac J Cancer Prev, 15, 1387-90. https://doi.org/10.7314/APJCP.2014.15.3.1387
  25. Liede A, Malik IA, Aziz Z, et al (2002). Contribution of BRCA1 and BRCA2 Mutations to Breast and Ovarian Cancer in Pakistan. Am J Hum Genet, 71, 595-606. https://doi.org/10.1086/342506
  26. Livi L, Meattini I, Saieva C, et al (2010). The impact of young age on breast cancer outcome. Eur J Surg Oncol, 36, 639-45. https://doi.org/10.1016/j.ejso.2010.05.016
  27. Litiere S, Werutsky G, Fentiman IS, et al (2012). Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 13, 412-9. https://doi.org/10.1016/S1470-2045(12)70042-6
  28. Morales L, Canney P, Dyczka J, et al (2007). European Organisation for Research and Treatment of Cancer Breast Group; Scottish Breast Cancer Trials Group. Postoperative adjuvant chemotherapy followed by adjuvant tamoxifen versus nil for patients with operable breast cancer: a randomised phase III trial of the European Organisation for Research and Treatment of Cancer Breast Group. Eur J Cancer, 43, 331-40. https://doi.org/10.1016/j.ejca.2006.10.009
  29. Mamoon N, Hassan U, Mushtaq S (2009). Breast carcinoma in young women aged 30 or less in Northern Pakistan - the Armed Forces Institute of Pathology experience. Asian Pac J Cancer Prev, 10, 1079-82.
  30. Miles RC, Gullerud RE, Lohse CM, et al (2012). Local recurrence after breast conservation surgery: Multivariable analysis of risk factors and the impact of age. Ann Surg Oncol, 19, 1153-9. https://doi.org/10.1245/s10434-011-2084-6
  31. Memon ZA, Shaikh AN, Rizwan S, Sardar MB (2013). Reasons for patient's delay in diagnosis of breast carcinoma in Pakistan. Asian Pac J Cancer Prev, 14, 7409-14. https://doi.org/10.7314/APJCP.2013.14.12.7409
  32. Rapiti E, Fioretta G, Verkooijen HM, et al (2005). Survival of young and older breast cancer patients in Geneva from 1990 to 2001. Eur J Cancer, 41, 1446-52. https://doi.org/10.1016/j.ejca.2005.02.029
  33. Sidoni A, Cavaliere A, Bellezza G, Scheibel M, Bucciarelli E (2003). Breast cancer in young women: clinicopathological features and biological specificity. Breast, 12, 247-50. https://doi.org/10.1016/S0960-9776(03)00095-X
  34. Shaukat U, Ismail M, Mehmood N (2013). Epidemiology, major risk factors and genetic predisposition for breast cancer in the Pakistani population. Asian Pac J Cancer Prev, 14, 5625-9. https://doi.org/10.7314/APJCP.2013.14.10.5625
  35. Thapa B, Singh Y, Sayami P, et al (2013). Breast cancer in young women from a low risk population in Nepal. Asian Pac J Cancer Prev, 14, 5095-9. https://doi.org/10.7314/APJCP.2013.14.9.5095
  36. Voogd AC, Nielsen M, Peterse JL, et al (2001). Differences inrisk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol, 19, 1688-97. https://doi.org/10.1200/JCO.2001.19.6.1688
  37. Vrieling C, Collette L, Fourquet A, et al (2003). EORTC Radiotherapy, Breast Cancer Groups. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer, 39, 932-44. https://doi.org/10.1016/S0959-8049(03)00123-0
  38. Wei R, Lau SS, Cheung PS (2010). Breast carcinoma in Chinese women: does age affect treatment choice and outcome? Asian J Surg, 33, 97-102. https://doi.org/10.1016/S1015-9584(10)60017-6
  39. Wang LW, Yang GF, Chen JM, et al (2014). A clinical database of breast cancer patients reveals distinctive clinico-pathological characteristics: a study from central China. Asian Pac J Cancer Prev, 15, 1621-6. https://doi.org/10.7314/APJCP.2014.15.4.1621

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  1. Discussing Genetic Testing With Patients With Breast Cancer in Developing Countries: Should We Be Judicious? vol.33, pp.35, 2015, https://doi.org/10.1200/JCO.2015.63.3974