Is Breast cancer in younger women a more aggressive variant? A comparative study

Abstract

Introduction: Breast cancer is the commonest malignancy in women in the world. About 5% of all breast cancer patients are 35 years old or younger. Current literature suggests that breast cancer in these younger women may be different in etiology, clinical features and outcome from the disease seen in older women. Patients and methods: We included all breast cancer patients who underwent surgical treatment at Surgical Unit IV, Jinnah hospital, Lahore from December, 1998 to December, 2003. All patients who left against medical advice or were lost to follow up before completing treatment at our hospital wee excluded. The patients were divided into two groups by age. Those who were 35 years old or younger were placed in group 1 (88 patients) and those older than 35 years were placed in group 11(54 patients), which served as the control group. We compared the clinical presentation, the risk factor profile, and the grade and the stage of the tumor at presentation in younger women and their older controls. Results: The mean age in group I was 29.38 years ± 3.68 years. While the mean age in group II was 44.41 years ± 7.64 years. The commonest mode of presentation in both groups was a painless lump. (93.2% in group I and 66.67% in group II; p value < 0.001). The distribution of classical risk factors was similar in the two groups. These included family history (12.5% in group I and 11.1% in group II), nulliparity (7.95% in group I and 7.4% in group II), and oral contraceptives use(14.77% in group I and 12.96% in group II). Younger patients presented with a greater number of poorly differentiated (Grade III) tumors compared to the older patients. (73.76% vs.24.07%; p value <0.001). They also presented more frequently with hormone insensitive tumors (79.55% in group I vs. 24.52% in group II ; p value < 0.001). Mammography was positive more often in older women compared to the younger ones (97.44% vs.41.38% ; p value < 0.001). Ultrasound was done in 67.05% of the younger women and 27.78% in the older women. It was suggestive of malignancy in 89.83% of the younger women and 86.67% of the older ones. Modified radical mastectomy was done in 75% of the younger patients (Group I) and 61.11% of the older patients (Group II). Radical mastectomy was done in 19.32% of group I patients and 27.78% of group II patients. Older women underwent breast conservation treatment more often than the younger women (11.11% vs. 5.68%; p value < 0.05) Adjuvant chemotherapy was given more often to younger women (73.86% in group I vs. 9.26% in group II; p value < 0.0001). On the other hand, older patients received hormonal therapy more often that the younger ones (74.07% vs. 20.45%; p value < 0.001). Younger patients also received adjuvant radiotherapy more frequently than their older counterparts (84.32% vs. 49.26; p value <0.05). Conclusion: We conclude that women with breast cancer who are 35 years old or younger have more aggressive tumors than the older patients i.e. they present at a higher stage with poorly differentiated tumors that are frequently hormone insensitive.