Background: While younger age at diagnosis has consistently been identified as a predictor of contralateral prophylactic mastectomy (CPM), little is known about how clinical, decisional, and psychosocial factors are related to the decision to undergo CPM in young women with breast cancer. Methods: As part of an ongoing, multi-center cohort study of young women diagnosed with breast cancer at age 40 or younger, we identified 428 women with unilateral Stage I-III disease. Participants were asked to complete surveys by mail that included questions about decision-making and treatments. Tumor characteristics were ascertained via medical record review. Multinomial logistic regression was used to identify predictors of: 1) CPM vs. unilateral mastectomy (UM); 2) CPM vs. breast conserving surgery (BCS). Independent variables with a p-value ≤ 0.15 in bi-variate analyses were included in the final multivariable model. Results: 41% of women had CPM, 29% had UM and 31% had BCS. Median age at diagnosis was 37 (range: 17-40). Most women had stage I or II disease (87%), and estrogen receptor (ER) positive tumors (69%); approximately 14% were carriers of a BRCA 1 or 2 mutation. In the multivariable analysis (Table 1), having a cancer-predisposing mutation, having at least one child, anxiety as measured by the Hospital Anxiety and Depression Scale (HADS), and patient-driven decision making were all associated with a greater likelihood of undergoing CPM, while women who reported their physician made the final decision about surgery were less likely to undergo CPM, compared to both UM and BCS. Additional factors significantly associated with undergoing CPM vs. BCS included nodal involvement, Her2 positivity, and lower BMI. Race/ethnicity, marital status, tumor size, tumor grade, depression (as measured by the HADS), fear of recurrence, and having a first-degree relative with breast or ovarian cancer were not associated with undergoing CPM. Conclusion: Many young women with early stage breast cancer are choosing to undergo CPM. Our findings point to the need for improved communication with patients regarding surgical choices as well as better management of anxiety surrounding diagnosis. Interventions aimed at enhancing risk communication and encouraging shared patient-physician decision-making might be beneficial in this setting. Table 1. Factors associated with: 1) CPM vs. UM; 2) CPM vs. BCS CPM vs. UMCPM vs. BCS OR (95% CI)OR (95% CI)Age at diagnosis0.92 (0.86-1.00)0.97 (0.90-1.04)Mutation positive3.83 (1.60-9.15)14.51 (5.02-41.92)Any nodal involvement0.79 (0.45-1.38)1.93 (1.05-3.55)Her2 positivity0.71 (0.40-1.26)2.24 (1.18-4.25)Having ≥ 1 child2.08 (1.04-4.14)3.25 (1.63-6.48)BMI0.98 (0.92-1.03)0.92 (0.87-0.97)Anxiety1.93 (1.05-3.56)2.31 (1.22-4.35)Decisional involvement (ref = shared)  Mainly patient's decision3.47 (1.99-6.06)3.71 (2.09-6.58)Mainly doctor's decision0.14 (0.03-0.63)0.16 (0.03-0.77) Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-02.

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Background: Previous research has suggested that young age at diagnosis is an independent risk factor for breast cancer recurrence and death. However, young women are more likely to develop more aggressive subtypes of breast cancer and no prior studies have adequately controlled for Her-2/neu status or anti-Her-2 treatment. We sought to evaluate whether age is a prognostic factor in the HERA trial, which is a large randomized phase III trial of women with Her-2 positive early stage breast cancer who were randomized to receive trastuzumab (for one or two years) or observation following (neo)-adjuvant chemotherapy. Methods: We used 2 year median follow-up data from the HERA trial and conducted Cox proportional hazards models. Age was dichotomized at ≥40 years versus > 41 years to evaluate its prognostic effect on outcomes in women who received trastuzumab and those who did not. Only patients included in the 1-year trastuzumab and observation arms were included in the present analysis. Results: Of the 1703 women randomized to one-year of trastuzumab and 1698 to observation, 722 (21%) were age 40 or younger at study entry. Younger women were more likely to have node negative (33% vs 37%), estrogen receptor (ER)-negative (56 % vs 49%), and progesterone receptor (PR)-positive disease (41% vs 32%). In separate Cox models controlling for T and N stage, grade, ER and PR status, chemotherapy, endocrine therapy, and menopausal status at randomization, disease-free survival (DFS) hazard ratios were consistent for women ≥40 years compared with > 41 years old patients, regardless of whether they were assigned to observation or to receive trastuzumab. DFS were as follow: observation group: HR (younger/older) = 1.09, p-value = 0.62; trastuzumab group: HR (younger/older) = 1.05, p-value = 0.84. There was no statistically significant interaction between age and treatment (p=0.94). Conclusions: In women with early stage Her-2/neu positive breast cancer in a large RCT, age was not an independent predictor of risk of early recurrence. Future research to investigate whether age is a predictor of later risk of recurrence or is a predictor among women with other tumor subtypes is warranted. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-09-12.

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