Breast cancer in young black women

Abstract

Background: Young age at breast cancer diagnosis is associated with negative prognostic outcomes, and breast cancer in black women often manifests at a young age. This study evaluated the effect of age on breast cancer management and outcomes in black women. Methods:This was a retrospective cohort study of all black women treated for invasive breast cancer between 2005 and 2010 at a specialized tertiary-care cancer centre. Clinical and treatment characteristics were compared by age. Kaplan-Meier methodology was used to estimate overall survival (OS) and disease-free survival (DFS).Results: A total of 666 black women were identified. Median BMI was 30 (range 17-56) kg/m 2 and median tumour size was 16 (1-155) mm. Most tumours were oestrogen receptor-positive (66⋅4 per cent). Women were stratified by age: less than 40 years (74, 11⋅1 per cent) versus 40 years or more (592, 88⋅9 per cent). Younger women were significantly more likely to have a mastectomy, axillary lymph node dissection and to receive chemotherapy, and were more likely to have lymphovascular invasion and positive lymph nodes, than older women. The 5-year OS rate was 88⋅0 (95 per cent c.i. 86⋅0 to 91⋅0) per cent and the 5-year DFS rate was 82⋅0 (79⋅0 to 85⋅0) per cent. There was no statistically significant difference in OS by age (P = 0⋅236). Although DFS was inferior in younger women on univariable analysis (71 versus 88 per cent; P < 0⋅001), no association was found with age on multivariable analysis. Conclusion: Young black women with breast cancer had more adverse pathological factors, received more aggressive treatment, and had worse DFS on univariable analysis. Young age at diagnosis was, however, not an independent predictor of outcome.

Risk Factors, Prognostic Factors, and Nomogram for Distant Metastasis in Breast Cancer Patients Without Lymph Node Metastasis

“…For instance, Rosa Mendoza determined that tumor stage, primary tumor size, and lymph node involvement were the major predictors of DM in adult breast cancer ( 14 ). Besides, the Black race and Her-2-enriched subtype were also identified as the risk factors of DM in a recent study ( 28 – 30 ). In the present study, we explored the prognostic factors of 1-, 3-, and 5-year CSS among 748 N0 patients with DM.…”

Cancer-Specific Survival Outcome in Early-Stage Young Breast Cancer: Evidence From the SEER Database Analysis

“…Over the past years, with an increasing prevalence of breast cancer worldwide ( 1 – 4 , 6 ), the comprehensive and individualized management for patients with this particular disease has gradually attracted much attention, especially in terms of young breast cancer ( 7 , 9 , 10 , 14 , 15 ). It was believed that age was an independent prognostic indicator among female breast cancer and younger age, especially under the age of 40 years, frequently presented a higher risk of locoregional metastasis, recurrence, and ultimately worse OS outcomes ( 7 , 10 , 12 ).…”

“…Over the past years, with an increasing prevalence of breast cancer worldwide ( 1 – 4 , 6 ), the comprehensive and individualized management for patients with this particular disease has gradually attracted much attention, especially in terms of young breast cancer ( 7 , 9 , 10 , 14 , 15 ). It was believed that age was an independent prognostic indicator among female breast cancer and younger age, especially under the age of 40 years, frequently presented a higher risk of locoregional metastasis, recurrence, and ultimately worse OS outcomes ( 7 , 10 , 12 ). Indeed, while surgery remained to be the first-line strategy in the management of breast cancer, great changes have taken place in terms of the surgical extension ( 8 , 16 ), especially with the wide application of neoadjuvant chemotherapy ( 17 , 18 ) and postoperative radiation therapy ( 19 ) for early-stage breast cancer.…”

“…As showed in the results of Cancer Statistics for Adolescents and Young Adults (2020 version) ( 5 ), young Black women had higher incidence rates of breast cancer than White as well as higher death rates (25.9 vs 22.3 per 100,000 population, 3.9 vs 2.0 per 100,000 population during 2012-2016, respectively). Most recently, Walsh et al ( 7 ) examined a large-scale population of young Black women with breast cancer and they confirmed the young Black women had worse disease-free survival (DFS) than old women, but OS was not significantly different. On the contrary, this divergence of OS or CSS in different races were disappeared among female patients with bone metastasis at presentation (p=0.282, p=0.413, respectively) ( 22 ).…”

“…Compared with elderly women, young patients, accounting for a relatively small number of breast cancer, were more likely to present aggressive subtypes and advanced disease, and the survival and outcomes were worse (5-year relative survival rate comparison: 86% vs 91% in elderly women) ( 5 ). Consequently, the strategies of treatment and prevention for young breast cancer have gradually aroused wide attention ( 7 – 11 ). Notably, in one study from China, young patients with breast cancer were more likely to have larger tumor size, poorer differentiation grade, a higher proportion of triple-negative breast cancer (TNBC), and more advanced stage, when compared with elder patients ( 11 ).…”