Breast cancer in young women: The effect of age on tumor biology and prognosis

Background: Breast cancer (BC) is primarily a disease of older or postmenopausal women. Due to the small number of reported patients and difficulty in diagnosing BC in younger women studying this disease in this group has been challenging. Controversy exists regarding the relationship between age and prognosis as young women have generally been found to have a poor prognosis. This study compares breast carcinoma in women above and below 35 years of age highlighting age as an adverse factor in the presentation, recurrence, and prognosis of the disease. Materials and Methods: Two hundred and seventy-nine patients, having undergone a BC operation at a tertiary-care center between June 2005 and June 2010 were studied. Prognosis of breast carcinoma in women above and below 35 years was compared based on the stage and grade of the disease at the time of presentation, estrogen receptor/progesterone receptor (ER/PR) and HER2/neu status, recurrent disease on follow-up and mortality. Comparisons between these factors in the two groups were drawn using SPSS version 16.0. Results: Forty-seven patients were under 35 years (16.8%), and 232 patients were older than 35 years (83.2%). Women under 35 presented more often with stage 3 or 4 as compared to the other group. Mammogram grades were similar in both age groups. 52.5% of women below 35 years were given neoadjuvant chemotherapy versus 31.5% of women above 35 years. 93% of women in both age groups underwent surgery. There was statistically significant increased ER/PR negativity, HER2/neu positivity among women under 35 years of age as compared to the older group. 12.76% of women below 35 years had locoregional recurrence versus 5.17% of women above 35 years. 17.02% of women below 35 years had metastasis at the time of follow-up versus 6.46% of women above 35 years. Mortality in women under 35 years was 23.4% compared to 16.37% in women above 35 years. Conclusions: Young age (<35 years) is strongly associated with several poor prognostic factors. There is a need for aggressive management of BC in these women to reduce the incidence of recurrence, metastasis, and mortality.