Long-term outcome in young women with breast cancer: a population-based study.
Whether young age at diagnosis of breast cancer is an independent risk factor for death remains controversial, and the question whether young age should be considered in treatment decisions is still to be answered.



From a population-based cohort of 22,017 women with breast cancer, all women <35 years (n = 471) were compared to a random sample of 700 women aged 35-69 years from the same cohort. Information on patient and tumor characteristics, treatment, and follow-up was collected from the medical records. Tissue microarrays were produced for analysis of classical biomarkers. Breast cancer-specific survival (BCSS), distant disease-free survival (DDFS), and locoregional recurrence-free survival (LRFS) by age were compared using women 50-69 years as reference.



At 10 years follow-up, women <35 years and 35-39 years had a worse BCSS [age <35 years 69 % (HR 2.75, 95 % CI 1.93-3.94), age 35-39 years 76 % (HR 2.33, 95 % CI 1.54-3.52), age 40-49 years 84 % (HR 1.53, 95 % CI 0.97-2.39), and age 50-69 years 89 % (reference)]. The worse BCSS was statistically significant in stages I-IIa and Luminal B tumors. At multivariate analysis age <35 years and 35-39 years confined a risk in LRFS (HR 2.13, 95 % CI 1.21-3.76 and HR 1.97, 95 % CI 1.06-3.68) but not in DDFS and BCSS. In the subgroup of women <40 years with luminal tumors stage I-IIa, low age remained an independent risk factor also in DDFS (HR 1.87, 95 % CI 1.03-3.44).



Young women have a high risk of systemic disease even when diagnosed in an early stage. The excess risk of relapse is most pronounced in Luminal B tumors, where low age is an independent prognostic factor of DDFS and LRFS.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. hanna.fredholm@ki.se.|Department of Breast- and Endocrine Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden. hanna.fredholm@ki.se.
Hanna
0000-0002-2136-6162
H
Fredholm
Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Kristina
K
Magnusson
Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
Linda S
LS
Lindström
Department of Surgical Sciences, Uppsala University Hospital, Regional Cancer Center, Uppsala University, Uppsala, Sweden.|Division of Cancer Studies, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Hans
H
Garmo
Department of Surgical Sciences, Uppsala University Hospital, Regional Cancer Center, Uppsala University, Uppsala, Sweden.
Sonja Eaker
SE
Fält
Department of Radiology, Oncology and Radiation Science, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
Henrik
H
Lindman
Department of Oncology and Pathology, Cancer Center Karolinska and Karolinska Oncology, Radiumhemmet, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Jonas
J
Bergh
Department of Surgical Sciences, Uppsala University Hospital, Regional Cancer Center, Uppsala University, Uppsala, Sweden.|Division of Cancer Studies, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Lars
L
Holmberg
Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Fredrik
F
Pontén
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.|Department of Breast- and Endocrine Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Jan
J
Frisell
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.|Department of Breast- and Endocrine Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Irma
I
Fredriksson
D000328:Adult; D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011379:Prognosis; D013997:Time Factors
D014408:Biomarkers, Tumor
Breast cancer; Early stage; Luminal B; Population-based; Prognosis; Subtype; Young age