Very Young Women With Breast Cancer Offer Treatment Challenge Annals of Oncology 13:273-279, 2002. "Very young women (<35 years) with operable breast cancer: features of disease at presentation" By Harvey McConnell Women under the age of 35 who develop breast cancer are more likely to have an endocrine-unresponsive tumor. They also have, most often, a higher grade as well as more extensively proliferating and vessel invading disease. However, a study by clinicians with the European Institute Of Oncology and University of Milan School of Medicine, Milan, Italy, show that pathological tumor size, nodal status and number of positive axillary lymph-nodes are similar with older women. Their findings do not support previous data indicating more advanced disease in younger patients at diagnosis of operable disease, the clinicians add. The clinicians point out that some 2 percent of patients with breast cancer are under the age of 35 at diagnosis. Breast cancer at a young age has been reported to have a more aggressive biological behavior and to be associated with a more unfavorable prognosis compared with the disease in older patients. Previous studies found that tumors in younger women were less well differentiated (higher grade), had a higher proliferating fraction and had more vascular invasion than those occurring in older patients. A review of the US National Cancer database shows that patients younger than 35 have more advanced disease at diagnosis and a poorer five year survival than older premenopausal patients. Similar findings have been reported from the Finnish Cancer Registry and other sources. However, data on treatment effects are largely dependent upon older series collected over several years, and extrapolation of data from older age cohorts. The clinicians in the current study evaluated biological features and stage at presentation for 1,427 consecutive premenopausal patients aged 50 years with first diagnosis of invasive breast cancer referred to surgery at the European Institute of Oncology from April 1997 to August 2000. A total of 185 patients (13 percent) were under the age of 35 ("very young") and 1, 242 (87 percent) were between 35 and 50 years of age ("less young"). Data evaluation included the patient's medical history, concurrent diseases, surgery, pathological evaluation and results of staging procedures (blood chemistry, hematological values, bone scan, chest film and upper abdominal ultrasound examination). Pathological assessment included evaluation of the primary tumor size, histological type and of lymph nodes status, including a sentinel node biopsy when applicable. The expression of estrogen receptors (ER), progesterone receptors (PgR) and presence of vascular invasion (VI) also were evaluated. Compared with less young patients, the very young patient group had a higher percentage of tumors classified as ER negative, vascular or lymphatic invasion, and pathological grade 3. There was no difference between the two groups for pathological tumor size (pN) and number of positive lymph nodes. The researchers declared that two important findings are related to responsiveness to endocrine therapy in very young patients with breast cancer. "The first relates to the observation in the current series that very young patients had tumors with less immunoreactivity for ER and PgR than older premenopausal patients." And, "the second finding relates to the reduced efficacy of adjuvant chemotherapy for "very young" patients with endocrine responsive tumors compared with 'less young' premenopausal women." Women diagnosed with breast cancer under the age of 35 are likely to have germ-line BRCA1 or BRCA2 mutations in up to 15-30 percent of cases. These mutations are more frequently associated with higher histological grade, lack of ERs and high proliferation rate. "It might be hypothesized that germ-line mutations could partially explain the more aggressive breast cancer in young patients. Information is scarce on the efficacy of endocrine therapies (tamoxifen, ovarian suppression or a combination of both) or of the cytotoxics with respect to the presence of BRCA1 and BRCA2 mutations. Focused investigations might allow improvement of treatment indications, which cannot be otherwise extrapolated from trials on an older population." Although data on prognosis and treatment outcomes are not available for the current series mainly due to the short follow-up, the clinicians concluded," the observed results indicate that a large group of very young patients presents with endocrine responsive disease and therefore might enjoy the effect of tailored endocrine systemic therapies. "On the other hand, endocrine therapies are not easy to offer to very young patients, and further investigations in this specific field are urgently needed." Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.