LUGANO, Switzerland – Breast cancer in young women is characterised by more aggressive biological features as compared to those arising in older patients but outcomes are good when guideline-recommended treatments are given, according to ESMO Spokesperson Dr. Matteo Lambertini from IRCCS Policlinico San Martino Hospital - University of Genoa, Italy, commenting on results of two studies presented during the ESMO Breast Cancer congress 2019, 2-4 May 2019 in Berlin, Germany.
Young age per se is not a reason to give more intensive treatment highlighted Lambertini: “Women under 40 years of age tend to be diagnosed with more aggressive breast cancer types – for example their tumours are more likely to be triple negative and HER2 positive. Despite this, survival and local recurrence rates are similar to those of the general population of breast cancer patients provided they receive appropriate treatment.”
The aggressiveness of the tumour
The aggressiveness of tumours is illustrated in a study from Portugal in 207 patients under 35 years. (1) Of all breast cancers, 5% occur in women under 35, making it the most common cancer in women of this age group. Regarding tumour subtypes, 20% were triple negative, 28% HER2 positive, and 4% luminal A versus 67% luminal B, confirming the higher percentages of more aggressive tumour subtypes in young women. After a median follow-up of 53.5 months, 85% of women were alive, 26 patients had developed metastases and three a local recurrence.
Study author Dr. Ines F. Eiriz, of the Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal, said: “Disease-free survival was longest in women with hormone receptor positive tumours, followed by those with HER2 positive disease, and lastly those with triple negative breast cancer. The median survival of patients without metastases was 130 months compared to 37 months for those with metastatic disease.” (2)
The recurrence of the tumour
A Swiss study looking at breast cancer recurrence in 359 women aged 50 years or younger, showed that during a median follow-up of 45.6 months, 14 patients developed local recurrence, six developed distant metastases, and nine developed both. (3) The median time to recurrence was 31 months. The three- and five-year risks for local recurrence were 4.7% and 9.5%, respectively. Rates of disease free survival were 94.3% and 91.2% at three and five years, respectively. The rate of overall survival at five years was 93%.
Study author Dr. Simona Cima, of the IOSI - Oncology Institute of Southern Switzerland, Bellinzona, Switzerland, said: “Most recurrences in these patients were local rather than metastatic. Our study is ongoing, and the next step is to identify predictors of local recurrence. For example, we will examine the likelihood of local recurrence according to HER2 and triple negative status.”
Lambertini said: “It’s not true that being diagnosed with breast cancer at a young age means poorer survival or higher chances of the cancer coming back, and these studies further confirm that. Proper guideline-recommended treatments should be given to all breast cancer patients regardless of their age. Special attention should be paid in these women on the potential side effects of anticancer therapies including the risk of infertility.”
Official Congress Hashtag: #ESMOBreast19
References
- Abstract 101P_PR ‘Breast Cancer in Young Women - a multi-center 10-year experience‘ will be presented by Ines F. Eiriz during the Poster Display session on Friday 3 May, 12:15 to 13:00 (CEST) in the Exhibition area. Annals of Oncology, Volume 30, 2019 Supplement 3, doi:10.1093/annonc/mdz095
- The data in the press release are the final data reported at the ESMO Breast Cancer Congress 2019 and are updated from the initial abstract
- Abstract 102P_PR ‘Breast cancer early recurrences in young women‘ will be presented by Simona Cima during the Poster Display session on Friday 3 May, 12:15 to 13:00 (CEST) in the Exhibition area. Annals of Oncology, Volume 30, 2019 Supplement 3, doi:10.1093/annonc/mdz095
I.F. Eiriz1, N.G. Pereira2, M.T. Neves3, M.V. Batista1, T.C. Tomás1, S. Braga4
1Unidade Clínica Autónoma de Oncologia, Hospital Prof. Doutor Fernando Fonseca, Lisboa, Portugal, 2Unidade Funcional de Oncologia, Centro Hospitalar Barreiro Montijo, Lisboa, Portugal, 3Serviço de Oncologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal, 4Unidade Clínica Autónoma de Oncologia, Hospital Prof. Doutor Fernando Fonseca, Hospital de Vila Franca de Xira, Hospitais CUF Lisboa, Lisboa, Portugal
Background: Breast cancer is the most frequent cancer diagnosed in adult young women in Europe. Although rare (<5% before 35 years), it is one of the leading causes of death in this age group. The aim of this study is to characterize a cohort of young women regarding incidence, tumor stage, biology, treatment and survival.
Methods: We present a retrospective multi-center study of women less than 35 years old, diagnosed with breast cancer between 2008 and 2017. A total of 207 patients from 5 centers were included. Thirty five were excluded: 27 due to lack of data, 1 due to two different synchronous tumors and 7 had ductal in situ carcinoma. Data was analyzed using IBM SPPS statistics.
Results: Median age was 31 years and ductal invasive carcinoma was the most frequent histologic subtype (91%). In the analysis of tumor subtype: 4% of tumors were luminal A, 20% luminal B HER2 positive, 47% luminal B HER2 negative, 8% HER2 positive (hormone receptor negative) and 20% triple negative. Forty eight percent of patients were diagnosed with early breast cancer, 45% were locally advanced and 6% had de novo metastatic cancer. Thirty nine percent of patients were treated with neoadjuvant chemotherapy (CT) and pathological complete response was obtained in 12%. Eighty three percent of patients were treated with adjuvant systemic therapy (CT or endocrine therapy), 18% exclusively with endocrine therapy. The median follow-up time was 53,5 months. Metastatic disease developed in 37 patients: 7 patients with bone metastasis only, 17 with both bone and visceral metastasis and 14 patients with central nervous system in addition to bone and visceral disease. The median survival of metastatic patients was 16,5 months. Local recurrence occurred in 3 patients with a median time of 27 months. Eighty five percent of these women are alive.
Conclusions: As expected, frequency of HER2 positive and triple negative tumors is increased in this age group, and the frequency of locally advanced and de novo metastatic disease is more prevalent. The median survival of metastatic patients is low in this age group as is the median survival. Due to more aggressive biology, initial staging and survival, the group of very young women with breast cancer deserves special treatment approaches.
Legal entity responsible for the study: Inês Fernandes Eiriz
Funding: Has not received any funding
Disclosure: All authors have declared no conflicts of interest.
S. Cima, E.K. Cekani, M. Valli, A. Richetti
Radiation Oncology, IOSI - Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
Background: Breast cancer is the most common cause of cancer in women worldwide, with more aggressive clinical behavior and poor outcomes in younger patients. This is to their increased risk of presenting with biologically aggressive types of cancer and at more advanced stage. Many studies have attempted to identify risk factors for local recurrence and distant metastases. The aim of this retrospective study was to analyze rates of recurrence in young patients with breast cancer treated at Ticino Breast Unit.
Methods: We analyzed medical records of 381 women ≤50 years old, with stage I-III invasive breast cancer, treated with curative intent, from 2010 to 2017. Demographics, tumor biology, type of surgery, neoadjuvant and adjuvant therapy, site of recurrence, time of recurrence and survival were assessed. Overall survival (OS) was defined as the time period from diagnosis to death from any cause. Disease-free survival (DFS) was defined as the time period from surgery to the first loco regional recurrence and/or metastases. Survival curves were calculated using Kaplan-Meier method.
Results: The median age at the time of diagnosis was 45 years (range 23 to 50 years). The median follow-up was 45.6 months (range 1 to 105 months). Twenty-two patients (5.8%) were lost to follow-up. Tumor relapse occurred in 29 cases (7.6%), among which 9 patients died. Fourteen patients (3.7%) developed a loco-regional recurrence, 6 patients (1.6%) developed distant metastases and 9 patients (2.4%) loco-regional plus distant metastases. The most common site of loco-regional failure was the omolateral breast (11 patients). Two patients developed a second tumor in the contralateral breast. The median interval to recurrence was 31 months (range 3 to 87 months). The 3-year and 5-year risk for loco-regional recurrence was 4.7% and 9.5% respectively. The 3-years and 5-year DFS was 94.3% and 91.2% respectively. The 5-years OS was 93.3%.
Conclusions: Loco-regional recurrence and distant metastases rates of our population do not differ from those published in literature. Further analysis is needed to recognize biological and clinical risk factors for recurrence, with the aim of identifying prognostic models and addressing therapies.
Legal entity responsible for the study: Radiation oncology clinic
Funding: Has not received any funding
Disclosure: All authors have declared no conflicts of interest.
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