Emerging Data and Current Challenges for Young, Old, Obese, or Male Patients with Breast Cancer

Abstract

There are distinct subgroups of patients who have historically been underrepresented in most prospective clinical trials in breast cancer, including the youngest and oldest patients, male patients, and those struggling with obesity. Herein, we review current and future directions in research for each of these special populations with breast cancer, highlighting significant knowledge gaps and priorities in tumor biology and heterogeneity, therapeutic decision making promotion of adherence, supportive care, and psychosocial and functional well-being. In younger women, future study should focus on the biological underpinnings of aggressive disease and optimizing adherence and treatment decision making while addressing their unique survivorship needs. The latter includes generating a scientific basis for interruption of therapy for pregnancy. Among older patients, interventions should focus on increasing clinical trial accrual, predicting and mitigating toxicity so that functional status can be optimized, tailoring needs for dose modification, and anticipating life expectancy in the context of competing causes of death. For men with breast cancer, we need worldwide collaboration to answer even basic questions on optimal treatment, supportive care, and survivorship strategies. Finally, for those struggling with obesity, we need to better understand the biological associations with cancer incidence, prognosis and outcome, and how we can best intervene to assure weight loss at the "right time." It is only through highly collaborative, far-reaching, prospective, multidisciplinary, patient-centered, and patient-engaged efforts that we can optimize the physical and psychologic outcomes for all patients with breast cancer.

Evaluation of recurrence patterns and survival in modern series of young women with breast cancer

“…Young age has been associated with delay in diagnosis of breast cancer and thus presentation at a later stage of disease. Treatment delay has also been shown to impact survival in older and younger women with breast cancer . The relative impact of diagnosis and treatment delay on recurrence and survival was not analyzed for this study, but would be of interest for future research.…”

Unmet Needs in Clinical Research in Breast Cancer: Where Do We Need to Go?

“…The articles by Freedman and Partridge and Reeder-Hayes and Anderson focus on micro- and macro- population issues that present challenges to actualizing and translating progress made beyond the traditional clinical trials setting. (27, 28) Of note, while these articles do not focus on biologic heterogeneity across populations, we do believe that this variable will continue to emerge as an important factor in breast cancer outcomes, and thus have included an arrow from population implementation and dissemination to biologic discovery and translational research in Figure 1. (29)…”

“…Similarly, challenges exist for the minority of breast cancer patients who are men and have historically been treated extrapolating from datasets and clinical studies comprised predominantly of women. (27) Each of these special populations face challenges which this article highlights along with the exciting ongoing work in these vulnerable groups of patients to elucidate and overcome them to optimize care and outcomes. Notably, the review does not cover all vulnerable subpopulations with long-standing or emerging recognition of unique medical and/or psychosocial concerns such as patients with substantial comorbidities, and LBGT individuals.…”

“…Specific issues related to causes of nonadherence and the need for rigorous determination of best therapies within and across populations are topics discussed in the FOCUS articles by Freedman and Reeder-Hayes. (27, 28)…”

Breast cancer in an 18-year-old female: A fatal case report and literature review

“…36,40 Consequently, BC at an early age (35 years or less) has a rather fatal prognosis. 9,33,35,36,[41][42][43] Herein we report a case of an 18-year-old female diagnosed initially with DCIS and later with invasive lobular BC who was found to be a carrier for a heterozygous c.5972C>T polymorphic variant of the BRCA2, a heterozygous p.Ile157Thr mutation for the CHEK2, a heterozygous p.Lys751Gln variant for the XPD, and a homozygous c.3020insC mutation for the NOD2, and died after a fulminant course of disease at the age of 22 years.…”