title: Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?
abstract: OBJECTIVE
  Primary objective was to verify whether breast cancer patients aged less than 40 years at diagnosis have poorer prognosis than older patients. Secondary to assess prognostic factors influencing disease free survival.
  
  
  METHODS
  941 women were diagnosed with non-metastatic breast cancer at NCI, Cairo in 2003. Epidemiologic, clinico-pathological characteristics, treatment modalities and disease free survival were compared among the two age groups. Prognostic factors were evaluated for association with disease-free survival.
  
  
  RESULTS
  One hundred-eighty-one patients (19.2%) were younger than 40 years and 760 (80.8%) were older. Older women presented with higher rates of comorbidities and younger women presented with more hormone non-responsive tumors. Young women presented with larger tumors pT4=13.8% compared to 8.6% in older women, yet not significant. Young women were treated with more conservative surgery, more adjuvant chemotherapy and radiotherapy while older women with more radical mastectomies and more hormonal treatment. Recurrence rates were significantly higher among young women 44.2% compared to 34.5% in older women. Five year disease free survival in young women was 38.9% ± 4.6% compared to 48.6% ± 2.5% with adjusted hazard ratio of 1.22 95% CI (0.91-1.64), p=0.19. Multivariate analyses identified positive axillary lymph nodes (pN2-pN3), larger tumor size (pT3-pT4), hypertension, lobular carcinoma type and lack of adjuvant systemic treatment as independent factors associated with poor DFS.
  
  
  CONCLUSIONS
  Young women were not found to have poorer prognosis, yet they presented with more ER negative tumors. Most of women presented with advanced stage and young women had higher recurrence rates.
authors.affiliation: Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt. Electronic address: nelly26660@gmail.com.
authors.forename: Nelly H
authors.initials: NH
authors.lastname: Alieldin
authors.affiliation: Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Omnia M
authors.initials: OM
authors.lastname: Abo-Elazm
authors.affiliation: Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Dalia
authors.initials: D
authors.lastname: Bilal
authors.affiliation: Department of Medical Oncology, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Salem Eid
authors.initials: SE
authors.lastname: Salem
authors.affiliation: Department of Pathology, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Gouda
authors.affiliation: Department of radiotherapy, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Magda
authors.initials: M
authors.lastname: Elmongy
authors.affiliation: Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
authors.forename: Amal S
authors.initials: AS
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast cancer; Disease-free survival; Prognostic factors; Young age