P5-14-25: Disease Presentation, Treatment, and Outcome in Young and Elderly Women with Breast Cancer.
Authors: Yu E , Yu D , Godette K , Mister D , Torres M 
Published: June 2012

Aim: To determine the influence of age on disease presentation, treatment, and outcome in breast cancer patients who are not routinely screened by mammography, women younger than 40 and women older than 69 years.

Methods: The records of 272 breast cancer patients who presented to the Emory University Department of Radiation Oncology between 1997 and 2010 were reviewed. We excluded women with inflammatory or Stage IV breast cancer and those diagnosed between the ages of 40 and 69. We compared presentation, staging, treatment, and outcomes in women younger than 40 with those older than 69. Results: The median age of the young and older patient groups were 31 (range 16–40) and 76 years (range 70–91), respectively. Young women more often presented with a symptomatic breast mass than older women whose cancers were more frequently detected on screening mammography (p&lt;.001). Young women were less likely than older women to present with significant co-morbidities including hypertension, diabetes, or cardiac disease (2% vs 76%, p&lt;.001). A higher proportion of young women had high grade (50% vs 25%), T2/T3 tumors (69% vs 26%), and node positive disease (50% vs 23%) (p&lt;.001 for all comparisons) than older women. Also, more young women had triple negative (25% vs 12.5%, p=.048) or HER2 positive breast cancers (34.4% vs. 18.3%, p=.02). Regarding treatment, older patients were less likely to undergo surgical axillary nodal staging (72% vs. 88%, p&lt;.04) or chemotherapy (23% vs 84%, p&lt;.001).

Among women treated with chemotherapy, older women more often received a non-anthracycline based regimen (82% vs 7% of young patients, p&lt;.001). Following neoadjuvant chemotherapy, significantly more young women had a complete pathological response (23% vs 13% in older women, p&lt;.03). Fifty-two percent of young women received mastectomy versus 14% of older women (p&lt;.001). In part due to their low rates of breast conserving surgery, younger women trended toward less radiation treatment (81% vs 90% in older women, p=.12). Among estrogen receptor positive patients, more young women received adjuvant endocrine therapy than older women (91.4% vs 72%, p=.05). The median follow-up period for the entire group was 38 months (range 1–160). At 3 years, young women were more likely to recur locoregionally (10% vs. 2%, p=.06) and distantly (16% vs 5%, p=.04) than older women, though both groups had comparable breast cancer-specific (96% vs 96%, p=0.2) and overall survival (96% vs 93%, p=.3). On multivariate analysis, old age was a significant predictor of poorer overall survival (p=.05), whereas initial tumor size and nodal status were independent predictors of breast cancer recurrence (p&lt;.05).

Discussion: Our data suggest that young women present with more advanced stage tumors than older patients and are subsequently treated with more aggressive surgery and systemic treatments, including chemotherapy and endocrine therapy. In spite of this, young women are more likely to develop breast cancer recurrence largely due to their higher T and N stages at diagnosis. Select women less than the age of 40 may benefit from screening and early detection of their breast cancers. Regardless, future studies aimed at developing better systemic treatments for younger breast cancer patients are warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-25.