Breast cancer in young women of age 35 years and below: Initial experience at a tertiary cancer center in South India

Abstract

Author(s): Sithara Aravind, Geetha Muttath*, Fathima Bincy, Mohandoss Murugesan, Sangeetha K Nayanar and Satheesan Balasubramanian

Introduction: Breast cancer in women aged less than 35 years is uncommon and accounts for 12% of all breast cancer in the West. Breast cancer in young women as defined in our study belongs to 35 years of age and below. In this population, breast carcinoma is the most common malignant disease and has the greatest mortality. Numerous clinical studies have confirmed that breast cancer in young women has a higher histologic grade, unfavourable hormonal status, and overall higher death rate compared to the older population of women. Background of the present study is that clinic pathological and survival data regarding Young Patients with Breast Cancer (YBC) in South Indian population are scarce and heterogeneous. To the best of knowledge there is no study about survival in young breast cancer under taken in Kerala population.

Aims and Objectives: To analyse the clinical, pathological, prognostic factors, treatment modalities and survival status of young females with breast cancer treated at our institution.

Materials and Methods: A retrospective single centre study of all female patients of age 35 yrs. and below with histological diagnosis of carcinoma breast, treated from January 2014 to December 2016.

Results: Of total 1686 breast cancer cases registered at our institution, 65 cases were females of age 35 years and below. Median age was 33 years. Four patients (6.1%) had family history of breast cancer. Left breast was the predominant site of occurrence. Infiltrating Ductal Carcinoma, Grade II was the most common histologic type and grade. 14 patients were Estrogen and Progesterone Receptor (ER PR) positive with Her 2 negativity. 60% patients were Her2 positive, irrespective of ERPR status. Most cases belonged to tumour stage T2. Surgery was the main stay of treatment and was undertaken by 90.8% patients (n-59). 5 year Overall Survival (OS) was 90% ,Median disease free survival was 56 months with 5 year Disease Free Survival (DFS) being 43%.Our cohort was divided into two groups, based on age , so as to compare their DFS. The first group belonged to age 25-30 years (n-11) and second group to age 31-35 years (n-54). There was no significant difference in 3 year DFS between the two groups (80% vs 87%, p value=0.432). The median DFS in patients was 56 (44-67) months, while median DFS was not attained in patients less than 30 years.

Conclusion: According to our study, the incidence of breast cancer in young females is high when compared to the published Western data but lower than available Indian data. It is also found to occur at a much younger age. The unique finding in our study is that though the patients present with Grade 2/3 invasive ductal carcinoma with a higher incidence of HER2 positivity, the 5 Year OS is 90% indicating a good survival status which is in contrast with the Western literature.

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