Age as a prognostic factor in breast cancer: Relationship to pathologic and biologic features

Abstract

The relationship of age with prognostic factors and outcome of breast cancer has long been controversial due to numerous confounding factors. In order to clarify the prognostic value of age, we analyzed a homogeneous population of 1,266 patients treated for breast cancer at the same institution (mean follow-up: 62 months). Three groups were compared: patients under 35 years of age, non-menopausal patients over 35 years of age, and post-menopausal patients under the age of 70 years. A higher frequency of undifferentiated tumors, histoprognostic grade-3 cancer, microscopic lymph-node involvement and negative hormonal receptor status was observed in patients under 35 years. In addition, clinical but not anatomical tumor size was greater in young patients, suggesting higher stromal activity. Metastasis-free survival and overall survival were significantly poorer before 35 years. Differences were observed when patients were matched with regard to stage, anatomic size, histoprognostic grade, microscopic lymph-node involvement and receptor status. Multivariate analysis of both overall and metastasis-free survival demonstrated that age younger than 35 years was an independent risk factor. Younger women had a higher risk of local recurrence but, unlike older women, they did not experience any worsening of the already unfavorable outcome due to recurrence.

CYP17 gene polymorphism and its association with high-risk north Indian breast cancer patients

“…The etiology of breast cancer in younger and older women differs in terms of inheritance, carcinogenesis and prognosis (Nixon et al 1994;Bonnier et al 1995). Hormonal risk is one of the non-genetic factors that may contribute to the disease's etiology.…”

Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women

“…[3][4][5][6][7][8][9] Although a possible contributing factor is that young patients may have more advanced disease at the time of diagnosis, other factors evidently play a role because young age has been shown in some studies to be an independent poor prognostic factor. Several studies have reported that tumor in younger patients tends to have more adverse pathologic characteristics, such as necrosis or undifferentiated, Grade 3 histology, 5,10,11 which may in part explain the worse outcome noted in these women. Nixon et al, 11 however, found that the worse outcome observed in their younger group was not fully explained by the more adverse pathologic features seen in these patients because young age remained a significant predictor of recurrence even after controlling for differences in histologic features.…”

Early-onset breast cancer – histopathological and prognostic considerations

“…There is a general perception that young age at diagnosis of breast cancer is associated with a poor prognosis (Earley et al, 1969;Brightmore et al, 1970;Noyes et al, 1982;Adami et al, 1986;Host and Lund, 1986;Ries et al, 1991;Sant et al, 1991;De La Rochefordiere et al, 1993;Bonnier et al, 1995). However, other studies suggest that patients who develop breast cancer at a young age have a similar prognosis to older patients and that management of young breast cancer patients is best dictated by standard clinical and histopathological criteria (Birks et al, 1973;Gogas and Skalkeas, 1975;Wallgren et al, 1977;Rosen et al, 1984;Backhouse et al, 1987;Barchielli et al, 1994).…”