title: Does guideline-adherent therapy improve the outcome for early-onset breast cancer patients?
abstract: OBJECTIVE
  Guidelines for the treatment of early-onset breast cancer have been proposed in several countries, but to date, their impact on outcomes is unverified. The objective of this study was to evaluate the association between guideline-adherent versus nonadherent treatment and recurrence-free survival (RFS) and overall survival (OAS) in early-onset breast cancer patients.
  
  
  METHODS
  A total of 1,778 patients were included in the study, of whom 111 were 35 years or younger and 1,667 were between 36 and 55 years. RFS and OAS were compared between the two groups, with respect to multiple parameters. All survival data were adjusted for tumor characteristics and analyzed with respect to guideline adherence according to the German Step 3 guidelines.
  
  
  RESULTS
  Statistically significant differences between the two groups (<35 years, 36-55 years) were observed with regard to breast surgery (p = 0.002) and hormone therapy (p = 0.006). Both groups were treated identically in terms of guideline adherence concerning axillary dissection (p = 0.9), radiation therapy (p = 0.7) and chemotherapy (p = 0.556). Young breast cancer patients whose treatment adhered to guideline recommendations had increased RFS and OAS [RFS: p = 0.030, hazard ratio (HR) 2.95, 95% confidence interval (CI) 1.11-7.83; OAS: p < or = 0.001, HR 2.92, 95% CI 2.01-4.23].
  
  
  CONCLUSIONS
  Guideline-adherent treatment for early-onset breast cancer patients significantly improves OAS and RFS and should therefore be demanded for all patients.
authors.affiliation: Universitätsfrauenklinik Ulm, Ulm, Deutschland. dominic.varga@me.com
authors.forename: Dominic
authors.initials: D
authors.lastname: Varga
authors.forename: Manfred
authors.initials: M
authors.lastname: Wischnewsky
authors.forename: Ziad
authors.initials: Z
authors.lastname: Atassi
authors.forename: Regine
authors.initials: R
authors.lastname: Wolters
authors.forename: Verena
authors.initials: V
authors.lastname: Geyer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Strunz
authors.forename: Rolf
authors.initials: R
authors.lastname: Kreienberg
authors.forename: Achim
authors.initials: A
authors.lastname: Woeckel
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome