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01-04-2018 | Epidemiology

Analysis of breast cancer in young women in the Department of Defense (DOD) database

Authors: Alexandra S. Zimmer, Kangmin Zhu, Patricia S. Steeg, Alex Wu, Margaret E. Gatti-Mays, Sanaz Soltani, Jeremy G. Perkins, Stephanie Shao, Derek Brown, Matthew Georg, Hai Hu, Craig D. Shriver, Stanley Lipkowitz

Published in: Breast Cancer Research and Treatment | Issue 2/2018

Abstract

Purpose

Breast tumors from young women under the age of 40 account for approximately 7% of cases and have a poor prognosis independent of established prognostic factors. We evaluated the patient population served by the Military Health System, where a disproportionate number of breast cancer cases in young women are seen and treated in a single universal coverage healthcare system.

Methods

The Military Health System Repository and the DoD Central Registration databases were used to identify female breast cancer patients diagnosed or treated at military treatment facilities from 1998 to 2007.

Results

10,066 women were diagnosed with invasive breast cancer at DoD facilities from 1998 to 2007, of which 11.3% (1139), 23.4% (2355) and 65.2% (6572) were < 40, 40–49 and > 50 years old (yo), respectively, at diagnosis. 53% in the < 40 yo cohort were white, 25% were African American (AA) and 8% were Hispanic, with 14% undisclosed. Breast cancer in women diagnosed < 40 yo was more high grade (p < 0.0001), Stage II (p < 0.0001) and ER negative (p < 0.0001). There was a higher rate of bilateral mastectomies among the women < 40 compared to those 40–49 and > 50 (18.4% vs. 9.1% and 5.0%, respectively). Independent of disease stage, chemotherapy was given more frequently to < 40 yo (90.43%) and 40–49 yo (81.44%) than ≥ 50 yo (53.71%). The 10-year overall survival of younger women was similar to the ≥ 50 yo cohort. Outcomes in the African American and Hispanic subpopulations were comparable to the overall cohort.

Conclusion

Younger women had a similar overall survival rate to older women despite receiving more aggressive treatment.

Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA 67(1):7–30PubMed

Brinton LA, Sherman ME, Carreon JD, Anderson WF (2008) Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst 100(22):1643–1648CrossRefPubMedPubMedCentral

Azim HA, Michiels S, Bedard PL, Singhal SK, Criscitiello C, Ignatiadis M et al (2012) Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res 18(5):1341–1351CrossRefPubMed

Cancello G, Maisonneuve P, Rotmensz N, Viale G, Mastropasqua MG, Pruneri G et al (2010) Prognosis and adjuvant treatment effects in selected breast cancer subtypes of very young women (< 35 years) with operable breast cancer. Ann Oncol 21(10):1974–1981CrossRefPubMed

Bharat A, Aft RL, Gao F, Margenthaler JA (2009) Patient and tumor characteristics associated with increased mortality in young women (≤ 40 years) with breast cancer. J Surg Oncol 100(3):248–251CrossRefPubMed

Brenner H, Hakulinen T (2004) Are patients diagnosed with breast cancer before age 50 years ever cured? J Clin Oncol 22(3):432–438CrossRefPubMed

van der Hage JA, Mieog JSD, van de Velde CJH, Putter H, Bartelink H, van de Vijver MJ (2011) Impact of established prognostic factors and molecular subtype in very young breast cancer patients: pooled analysis of four EORTC randomized controlled trials. Breast Cancer Res 13(3):R68CrossRefPubMedPubMedCentral

Liu YR, Jiang YZ, Yu KD, Shao ZM (2015) Different patterns in the prognostic value of age for breast cancer-specific mortality depending on hormone receptor status: a SEER population-based analysis. Ann Surg Oncol 22(4):1102–1110CrossRefPubMed

Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G et al (2002) Very young women (< 35 years) with operable breast cancer: features of disease at presentation. Ann Oncol 13(2):273–279CrossRefPubMed

10.

Han W, Kang S, The Korean Breast Cancer Society (2010) Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer. Breast Cancer Res Treat 119(1):193–200CrossRefPubMed

11.

Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S et al (2012) Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat 131(3):1061–1066CrossRefPubMed

12.

Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS ONE 4(11):A38–A46CrossRef

13.

Kataoka A, Iwamoto T, Tokunaga E, Tomotaki A, Kumamaru H, Miyata H et al (2016) Young adult breast cancer patients have a poor prognosis independent of prognostic clinicopathological factors: a study from the Japanese Breast Cancer Registry. Breast Cancer Res Treat 160(1):163–172CrossRefPubMedPubMedCentral

14.

Yao YQ, Cao MQ, Fang H, Xie JP (2015) Breast cancer in 30-year-old or younger patients: clinicopathologic characteristics and prognosis. World J Surg Oncol 13:38CrossRefPubMedPubMedCentral

15.

Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress RI et al (2013) Prospective observational study of breast cancer treatment outcomes for UK women aged 1840 years at diagnosis: the POSH study. J Natl Cancer Inst 105(13):978–988CrossRefPubMed

16.

Chollet-Hinton L, Anders CK, Tse CK, Bell MB, Yang YC, Carey LA et al (2016) Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: a case-control study. Breast Cancer Res 8(1):79CrossRef

17.

Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y et al (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 26(20):3324–3330CrossRefPubMed

18.

Partridge AH, Hughes ME, Warner ET, Ottesen RA, Wong YN, Edge SB et al (2016) Subtype-dependent relationship between young age at diagnosis and breast cancer survival. J Clin Oncol 34(27):3308–3314CrossRefPubMed

19.

Ademuyiwa FO, Gao F, Hao L, Morgensztern D, Aft RL, Ma CX et al (2015) US breast cancer mortality trends in young women according to race. Cancer 121(9):1469–1476CrossRefPubMed

20.

Clarke CA, Keegan THM, Yang J, Press DJ, Kurian AW, Patel AH et al (2012) Age-specific incidence of breast cancer subtypes: understanding the Black–White crossover. J Natl Cancer Inst 104(14):1094–1101CrossRefPubMedPubMedCentral

21.

Liu P, Li X, Mittendorf EA, Li J, Du XL, He J et al (2013) Comparison of clinicopathologic features and survival in young American women aged 18–39 years in different ethnic groups with breast cancer. Br J Cancer 109(5):1302–1309CrossRefPubMedPubMedCentral

22.

Amirikia KC, Mills P, Bush J, Newman LA (2011) Higher population-based incidence rates of triple-negative breast cancer among young African–American women implications for breast cancer screening recommendations. Cancer 117(12):2747–2753CrossRefPubMedPubMedCentral

23.

Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA (2009) Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg 208(3):341–347CrossRefPubMedPubMedCentral

24.

Kirby JB, Kaneda T (2010) Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach. Demography 47(4):1035–1051CrossRefPubMedPubMedCentral

25.

Bland KI, Menck HR, Scott-Conner CEH, Morrow M, Winchester DJ, Winchester DP (1998) The national cancer data base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer 83(6):1262–1273CrossRefPubMed

26.

Fredholm H, Magnusson K, Lindstrom LS, Garmo H, Falt SE, Lindman H et al (2016) Long-term outcome in young women with breast cancer: a population-based study. Breast Cancer Res Treat 160(1):131–143CrossRefPubMedPubMedCentral

27.

Warner ET, Colditz GA, Palmer JR, Partridge AH, Rosner BA, Tamimi RM (2013) Reproductive factors and risk of premenopausal breast cancer by age at diagnosis: are there differences before and after age 40? Breast Cancer Res Treat 142(1):165–175CrossRefPubMed

28.

Anders CK, Fan C, Parker JS, Carey LA, Blackwell KL, Klauber-DeMore N et al (2011) Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes? J Clin Oncol 29(1):E18–E20CrossRefPubMed

29.

Aalders KC, Postma EL, Strobbe LJ, van der Heiden-van der Loo M, Sonke GS, Boersma LJ et al (2016) Contemporary locoregional recurrence rates in young patients with early-stage breast cancer. J Clin Oncol 34(18):2107–2114CrossRefPubMed

30.

Plichta JK, Rai U, Tang R, Coopey SB, Buckley JM, Gadd MA et al (2016) Factors associated with recurrence rates and long-term survival in women diagnosed with breast cancer ages 40 and younger. Ann Surg Oncol 23(10):3212–3220CrossRefPubMed

31.

Gradishar W (2006) Landmark trials in endocrine adjuvant therapy for breast carcinoma. Cancer 106(5):975–981CrossRefPubMed

32.

Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134(2):459–478CrossRefPubMedPubMedCentral

33.

Daly B, Olopade OI, Hou N, Yao K, Winchester DJ, Huo D (2017) Evaluation of the quality of adjuvant endocrine therapy delivery for breast cancer care in the United States. JAMA Oncol 3(7):928–935CrossRefPubMedPubMedCentral

34.

Partridge AH, Pagani O, Abulkhair O, Aebi S, Amant F, Azim HA et al (2014) First international consensus guidelines for breast cancer in young women (BCY1). Breast 23(3):209–220CrossRefPubMed

35.

Chen HL, Zhou MQ, Tian W, Meng KX, He HF (2016) Effect of age on breast cancer patient prognoses: a population-based study using the SEER 18 database. PloS ONE 11(10):e0165409CrossRefPubMedPubMedCentral

36.

Melin J (2016) Desperate choices: why Black women join the US military at higher rates than men and all other racial and ethnic groups. N Engl J Public Policy 28(2):1–14

Title: Analysis of breast cancer in young women in the Department of Defense (DOD) database
Authors: Alexandra S. Zimmer
Kangmin Zhu
Patricia S. Steeg
Alex Wu
Margaret E. Gatti-Mays
Sanaz Soltani
Jeremy G. Perkins
Stephanie Shao
Derek Brown
Matthew Georg
Hai Hu
Craig D. Shriver
Stanley Lipkowitz
Publication date: 01-04-2018
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4615-8

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