title: Functional impact of breast cancer by age at diagnosis.
abstract: OBJECTIVE
  To explore changes in physical and psychosocial function before and after breast cancer by age at diagnosis.
  
  
  METHODS
  A total of 122,969 women from the Nurses' Health Study (NHS) and NHS 2, ages 29 to 71 years, who responded to pre- and postfunctional status assessments were included; 1,082 women were diagnosed with breast cancer between 1992 and 1997. Functional status was measured using the Medical Outcomes Study Short Form 36 (SF-36). Mean change in health-related quality of life (HRQoL) scores was computed across categories representing the combination of incident breast cancer (yes or no) and age at diagnosis (< or = 40, 41 to 64, or 65+ years).
  
  
  RESULTS
  Compared with women < or = 40 years without breast cancer, women with breast cancer experienced significant functional declines. Young (age < or = 40) women who developed breast cancer experienced the largest relative declines in HRQoL (as compared with middle-aged and elderly women) in multiple domains including physical roles (-18.8 v -11.5 and -7.5 points, respectively), bodily pain (-9.0 v -2.7 and -2.7 points), social functioning (-11.3 v -4.3 and -4.4 points) and mental health (-3.1 v 0.0 and +0.4 points). Much of the decline in HRQoL among elderly (age > or = 65) women with breast cancer was age related.
  
  
  CONCLUSIONS
  Young women may fare worse than middle-aged or elderly women in both physical and psychosocial dimensions after breast cancer diagnosis. The needs of women facing breast cancer may be better understood within a life stage framework.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. candyce.kroenke@channing.harvard.edu
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.forename: Bernard
authors.initials: B
authors.lastname: Rosner
authors.forename: Wendy Y
authors.initials: WY
authors.lastname: Chen
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology