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Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Breast Cancer | Research

Effect of young age (below 40 years) on oncologic outcomes in Lebanese patients with breast cancer: a matched cohort study

Authors: Eman Sbaity, Hani Tamim, Ghada El-Hajj Fuleihan, Jaber Abbas, Mariam Zahwe, Razan El Sayed, Ali Shamseddine

Published in: BMC Cancer | Issue 1/2024

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Abstract

Background

Developing countries have a significantly higher incidence of breast cancer in patients younger than 40 years as compared to developed countries. This study aimed to examine if young age at diagnosis is an independent prognostic factor for worse survival outcomes in breast cancer as well as the effect of age on Disease-free survival (DFS) and local recurrence free survival (LRFS) after adjusting for various tumor characteristics, local and systemic treatments.

Methods

This is a secondary analysis of prospective cohort of patients from two existing databases. We identified patients with breast cancer aged 40 years or less and we matched them to those older than 40 years. We also matched based on stage and molecular subtypes. In cohort 1, we matched at a ratio of 1:1, while in cohort 2 we matched at a ratio of 1:3.

Results

In cohort 1, Disease-free survival (DFS) at 5 years was significantly shorter for those younger than 40 years (75.6% and 92.7% respectively; p < 0.03). On multivariate analysis, only chemotherapy was found to be significant, while age was not found to be an independent predictor of prognosis. Local recurrence free survival at 5 years was similar between both age categories. Only hormonal therapy is a significant predictor for LRFS at 5 years. In the second cohort, DFS and LRFS at 3 years were similar between those younger and those older than 40 years. On multivariate analysis, no factor including age was found to be an independent predictor of prognosis.

Conclusion

Data in the literature is controversial on the effect of young age on breast cancer prognosis. Our findings could not demonstrate that age is an independent prognostic factor in our population. There is a need for outcomes from larger, prospective series that have longer follow-ups and more data from our region.
Literature
2.
go back to reference Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer statistics in the European Union: incidence and survival across European Countries. Breast Care. 2019;14(6):344–53.CrossRefPubMedPubMedCentral Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer statistics in the European Union: incidence and survival across European Countries. Breast Care. 2019;14(6):344–53.CrossRefPubMedPubMedCentral
3.
go back to reference Obiorah CC, Abu EK. Breast cancer in Rivers State, Nigeria: ten-year review of the Port Harcourt cancer registry. South Afr J Oncol. 2019;3. Obiorah CC, Abu EK. Breast cancer in Rivers State, Nigeria: ten-year review of the Port Harcourt cancer registry. South Afr J Oncol. 2019;3.
4.
go back to reference Mehdi I, Monem EA, Bahrani BJA, Kharusi SA, Nada AM, Lawati JA, et al. Age at diagnosis of female breast cancer in Oman: issues and implications. South Asian J Cancer. 2014;03(02):101–6.CrossRef Mehdi I, Monem EA, Bahrani BJA, Kharusi SA, Nada AM, Lawati JA, et al. Age at diagnosis of female breast cancer in Oman: issues and implications. South Asian J Cancer. 2014;03(02):101–6.CrossRef
5.
go back to reference El Saghir NS. Increased age adjusted incidence rates in younger-aged groups at presentation. In Lebanon and arab countries. Implications for screening and for europeans, australians and americans of Arabic origins. Eur J Cancer Suppl. 2004;2(3):187–8.CrossRef El Saghir NS. Increased age adjusted incidence rates in younger-aged groups at presentation. In Lebanon and arab countries. Implications for screening and for europeans, australians and americans of Arabic origins. Eur J Cancer Suppl. 2004;2(3):187–8.CrossRef
6.
go back to reference Bharat A, Aft RL, Gao F, Margenthaler JA. Patient and tumor characteristics associated with increased mortality in young women (≤ 40 years) with breast cancer: young women with breast Cancer. J Surg Oncol. 2009;100(3):248–51.CrossRefPubMed Bharat A, Aft RL, Gao F, Margenthaler JA. Patient and tumor characteristics associated with increased mortality in young women (≤ 40 years) with breast cancer: young women with breast Cancer. J Surg Oncol. 2009;100(3):248–51.CrossRefPubMed
7.
go back to reference Elkum N, Dermime S, Ajarim D, Al-Zahrani A, Alsayed A, Tulbah A, et al. Being 40 or younger is an independent risk factor for relapse in operable breast cancer patients: the Saudi Arabia experience. BMC Cancer. 2007;7(1):222.CrossRefPubMedPubMedCentral Elkum N, Dermime S, Ajarim D, Al-Zahrani A, Alsayed A, Tulbah A, et al. Being 40 or younger is an independent risk factor for relapse in operable breast cancer patients: the Saudi Arabia experience. BMC Cancer. 2007;7(1):222.CrossRefPubMedPubMedCentral
8.
go back to reference AlZaman AS, Mughal SA, AlZaman YS, AlZaman ES. Correlation between hormone receptor status and age, and its prognostic implications in breast cancer patients in Bahrain. SMJ. 2016;37(1):37–42.CrossRef AlZaman AS, Mughal SA, AlZaman YS, AlZaman ES. Correlation between hormone receptor status and age, and its prognostic implications in breast cancer patients in Bahrain. SMJ. 2016;37(1):37–42.CrossRef
9.
go back to reference Peng R, Wang S, Shi Y, Liu D, Teng X, Qin T, et al. Patients 35 years old or younger with operable breast cancer are more at risk for relapse and survival: a retrospective matched case–control study. The Breast. 2011;20(6):568–73.CrossRefPubMed Peng R, Wang S, Shi Y, Liu D, Teng X, Qin T, et al. Patients 35 years old or younger with operable breast cancer are more at risk for relapse and survival: a retrospective matched case–control study. The Breast. 2011;20(6):568–73.CrossRefPubMed
10.
go back to reference Chouchane L, Boussen H, Sastry KSR. Breast cancer in arab populations: molecular characteristics and disease management implications. Lancet Oncol. 2013;14(10):e417–e24.CrossRefPubMed Chouchane L, Boussen H, Sastry KSR. Breast cancer in arab populations: molecular characteristics and disease management implications. Lancet Oncol. 2013;14(10):e417–e24.CrossRefPubMed
11.
go back to reference Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G, et al. Very young women (< 35 years) with operable breast cancer: features of disease at presentation. Ann Oncol. 2002;13(2):273–9.CrossRefPubMed Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G, et al. Very young women (< 35 years) with operable breast cancer: features of disease at presentation. Ann Oncol. 2002;13(2):273–9.CrossRefPubMed
12.
go back to reference Albain KS, Allred DC, Clark GM. Breast cancer outcome and predictors of outcome: are there age differentials? J Natl Cancer Inst Monogr. 1994(16):35–42. Albain KS, Allred DC, Clark GM. Breast cancer outcome and predictors of outcome: are there age differentials? J Natl Cancer Inst Monogr. 1994(16):35–42.
13.
go back to reference Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. JCO. 1994;12(5):888–94.CrossRef Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. JCO. 1994;12(5):888–94.CrossRef
14.
go back to reference Azim HA, Michiels S, Bedard PL, Singhal SK, Criscitiello C, Ignatiadis M, et al. Elucidating Prognosis and Biology of breast Cancer arising in Young Women using gene expression profiling. Clin Cancer Res. 2012;18(5):1341–51.CrossRefPubMed Azim HA, Michiels S, Bedard PL, Singhal SK, Criscitiello C, Ignatiadis M, et al. Elucidating Prognosis and Biology of breast Cancer arising in Young Women using gene expression profiling. Clin Cancer Res. 2012;18(5):1341–51.CrossRefPubMed
15.
go back to reference Adami H-O, Malker B, Holmberg L, Persson I, Stone B. The relation between survival and age at diagnosis in breast Cancer. N Engl J Med. 1986;315(9):559–63.CrossRefPubMed Adami H-O, Malker B, Holmberg L, Persson I, Stone B. The relation between survival and age at diagnosis in breast Cancer. N Engl J Med. 1986;315(9):559–63.CrossRefPubMed
16.
go back to reference de la Rochefordière A, Campana F, Fenton J, Vilcoq JR, Fourquet A, Asselain B, et al. Age as prognostic factor in premenopausal breast carcinoma. The Lancet. 1993;341(8852):1039–43.CrossRef de la Rochefordière A, Campana F, Fenton J, Vilcoq JR, Fourquet A, Asselain B, et al. Age as prognostic factor in premenopausal breast carcinoma. The Lancet. 1993;341(8852):1039–43.CrossRef
17.
go back to reference Dubsky PC, Gnant MFX, Taucher S, Roka S, Kandioler D, Pichler-Gebhard B, et al. Young Age as an independent adverse prognostic factor in Premenopausal patients with breast Cancer. Clin Breast Cancer. 2002;3(1):65–72.CrossRefPubMed Dubsky PC, Gnant MFX, Taucher S, Roka S, Kandioler D, Pichler-Gebhard B, et al. Young Age as an independent adverse prognostic factor in Premenopausal patients with breast Cancer. Clin Breast Cancer. 2002;3(1):65–72.CrossRefPubMed
18.
go back to reference Oh JL, Bonnen M, Outlaw ED, Schechter NR, Perkins GH, Strom EA, et al. The impact of young age on locoregional recurrence after doxorubicin-based breast conservation therapy in patients 40 years old or younger: how young is young? Int J Radiation Oncology*Biology*Physics. 2006;65(5):1345–52.CrossRef Oh JL, Bonnen M, Outlaw ED, Schechter NR, Perkins GH, Strom EA, et al. The impact of young age on locoregional recurrence after doxorubicin-based breast conservation therapy in patients 40 years old or younger: how young is young? Int J Radiation Oncology*Biology*Physics. 2006;65(5):1345–52.CrossRef
19.
go back to reference Liedtke C, Hess KR, Karn T, Rody A, Kiesel L, Hortobagyi GN, et al. The prognostic impact of age in patients with triple-negative breast cancer. Breast Cancer Res Treat. 2013;138(2):591–9.CrossRefPubMed Liedtke C, Hess KR, Karn T, Rody A, Kiesel L, Hortobagyi GN, et al. The prognostic impact of age in patients with triple-negative breast cancer. Breast Cancer Res Treat. 2013;138(2):591–9.CrossRefPubMed
20.
go back to reference Recht A, Connolly JL, Schnitt SJ, Silver B, Rose MA, Love S, et al. The effect of young age on tumor recurrence in the treated breast after conservative surgery and radiotherapy. Int J Radiation Oncology*Biology*Physics. 1988;14(1):3–10.CrossRef Recht A, Connolly JL, Schnitt SJ, Silver B, Rose MA, Love S, et al. The effect of young age on tumor recurrence in the treated breast after conservative surgery and radiotherapy. Int J Radiation Oncology*Biology*Physics. 1988;14(1):3–10.CrossRef
21.
go back to reference Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, et al. Why are local recurrences after breast-conserving therapy more frequent in younger patients? JCO. 1990;8(4):591–8.CrossRef Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, et al. Why are local recurrences after breast-conserving therapy more frequent in younger patients? JCO. 1990;8(4):591–8.CrossRef
22.
go back to reference Kurtz JM, Spitalier J-M, Amalric R, Brandone H, Ayme Y, Bressac C, et al. Mammary recurrences in women younger than forty. Int J Radiation Oncology*Biology*Physics. 1988;15(2):271–6.CrossRef Kurtz JM, Spitalier J-M, Amalric R, Brandone H, Ayme Y, Bressac C, et al. Mammary recurrences in women younger than forty. Int J Radiation Oncology*Biology*Physics. 1988;15(2):271–6.CrossRef
23.
go back to reference Kim SH, Simkovich-Heerdt A, Tran KN, Maclean B, Borgen PI. Women 35 years of age or younger have higher Locoregional Relapse Rates after undergoing breast conservation therapy. J Am Coll Surg. 1998;187(1):1–8.CrossRefPubMed Kim SH, Simkovich-Heerdt A, Tran KN, Maclean B, Borgen PI. Women 35 years of age or younger have higher Locoregional Relapse Rates after undergoing breast conservation therapy. J Am Coll Surg. 1998;187(1):1–8.CrossRefPubMed
24.
go back to reference van der Sangen MJC, Poortmans PMP, Scheepers SWM, Lemaire BMD, van Berlo CLH, Tjan-Heijnen VCG, et al. Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol (EJSO). 2013;39(8):892–8.CrossRefPubMed van der Sangen MJC, Poortmans PMP, Scheepers SWM, Lemaire BMD, van Berlo CLH, Tjan-Heijnen VCG, et al. Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol (EJSO). 2013;39(8):892–8.CrossRefPubMed
25.
go back to reference Kroman N, Holtveg H, Wohlfahrt J, Jensen M-B, Mouridsen HT, Blichert-Toft M, et al. Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer. 2004;100(4):688–93.CrossRefPubMed Kroman N, Holtveg H, Wohlfahrt J, Jensen M-B, Mouridsen HT, Blichert-Toft M, et al. Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer. 2004;100(4):688–93.CrossRefPubMed
26.
go back to reference Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnostic delays in young women: breast ca Presentation in Young Women. Cancer. 2014;120(1):20–5.CrossRefPubMed Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnostic delays in young women: breast ca Presentation in Young Women. Cancer. 2014;120(1):20–5.CrossRefPubMed
27.
go back to reference Foxcroft LM, Evans EB, Porter AJ. The diagnosis of breast cancer in women younger than 40. The Breast. 2004;13(4):297–306.CrossRefPubMed Foxcroft LM, Evans EB, Porter AJ. The diagnosis of breast cancer in women younger than 40. The Breast. 2004;13(4):297–306.CrossRefPubMed
28.
go back to reference Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131(3):1061–6.CrossRefPubMed Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131(3):1061–6.CrossRefPubMed
29.
go back to reference Adami H-O, Malker B, Meirik O, Persson I, Bergkvist L, Stone B. Age as a prognostic factor in breast cancer. Cancer. 1985;56(4):898–902.CrossRefPubMed Adami H-O, Malker B, Meirik O, Persson I, Bergkvist L, Stone B. Age as a prognostic factor in breast cancer. Cancer. 1985;56(4):898–902.CrossRefPubMed
30.
go back to reference Fowble BL, Schultz DJ, Overmoyer B, Solin LJ, Fox K, Jardines L, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiation Oncology*Biology*Physics. 1994;30(1):23–33.CrossRef Fowble BL, Schultz DJ, Overmoyer B, Solin LJ, Fox K, Jardines L, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiation Oncology*Biology*Physics. 1994;30(1):23–33.CrossRef
31.
go back to reference Chung M, Chang HR, Bland KI, Wanebo HJ. Younger women with breast carcinoma have a poorer prognosis than older women. Cancer. 1996;77(1):97–103.CrossRefPubMed Chung M, Chang HR, Bland KI, Wanebo HJ. Younger women with breast carcinoma have a poorer prognosis than older women. Cancer. 1996;77(1):97–103.CrossRefPubMed
32.
go back to reference Ahn SH, Son BH, Kim SW, Kim SI, Jeong J, Ko S-S, et al. Poor outcome of hormone receptor–positive breast Cancer at very young age is due to tamoxifen resistance: Nationwide Survival Data in Korea—A Report from the Korean breast Cancer Society. JCO. 2007;25(17):2360–8.CrossRef Ahn SH, Son BH, Kim SW, Kim SI, Jeong J, Ko S-S, et al. Poor outcome of hormone receptor–positive breast Cancer at very young age is due to tamoxifen resistance: Nationwide Survival Data in Korea—A Report from the Korean breast Cancer Society. JCO. 2007;25(17):2360–8.CrossRef
33.
go back to reference Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H. Breast Cancer in Young women: poor survival despite intensive treatment. PLoS ONE. 2009;4(11):e7695.CrossRefPubMedPubMedCentral Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H. Breast Cancer in Young women: poor survival despite intensive treatment. PLoS ONE. 2009;4(11):e7695.CrossRefPubMedPubMedCentral
34.
go back to reference Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA. 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. 2009;208(3):341–7.CrossRefPubMedPubMedCentral Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA. 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. 2009;208(3):341–7.CrossRefPubMedPubMedCentral
35.
go back to reference Xiong Q, Valero V, Kau V, Kau S-W, Taylor S, Smith TL, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M. D. Anderson Cancer Center experience. Cancer. 2001;92(10):2523–8.CrossRefPubMed Xiong Q, Valero V, Kau V, Kau S-W, Taylor S, Smith TL, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M. D. Anderson Cancer Center experience. Cancer. 2001;92(10):2523–8.CrossRefPubMed
36.
go back to reference El Saghir NS, Seoud M, Khalil MK, Charafeddine M, Salem ZK, Geara FB, et al. Effects of young age at presentation on survival in breast cancer. BMC Cancer. 2006;6(1):194.CrossRefPubMedPubMedCentral El Saghir NS, Seoud M, Khalil MK, Charafeddine M, Salem ZK, Geara FB, et al. Effects of young age at presentation on survival in breast cancer. BMC Cancer. 2006;6(1):194.CrossRefPubMedPubMedCentral
37.
go back to reference Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST. Stage 0 to stage III breast cancer in young women1. J Am Coll Surg. 2000;190(5):523–9.CrossRefPubMed Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST. Stage 0 to stage III breast cancer in young women1. J Am Coll Surg. 2000;190(5):523–9.CrossRefPubMed
38.
go back to reference Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute randomized trial. Cancer. 2003;98(4):697–702.CrossRefPubMed Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute randomized trial. Cancer. 2003;98(4):697–702.CrossRefPubMed
39.
go back to reference Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast Cancer. N Engl J Med. 1995;332(14):907–11.CrossRefPubMed Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast Cancer. N Engl J Med. 1995;332(14):907–11.CrossRefPubMed
40.
go back to reference Beadle BM, Woodward WA, Tucker SL, Outlaw ED, Allen PK, Oh JL, et al. Ten-year recurrence rates in young women with breast cancer by locoregional treatment approach. Int J Radiat Oncol Biol Phys. 2009;73(3):734–44.CrossRefPubMed Beadle BM, Woodward WA, Tucker SL, Outlaw ED, Allen PK, Oh JL, et al. Ten-year recurrence rates in young women with breast cancer by locoregional treatment approach. Int J Radiat Oncol Biol Phys. 2009;73(3):734–44.CrossRefPubMed
41.
go back to reference Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134(2):459–78.CrossRefPubMedPubMedCentral Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134(2):459–78.CrossRefPubMedPubMedCentral
Metadata
Title
Effect of young age (below 40 years) on oncologic outcomes in Lebanese patients with breast cancer: a matched cohort study
Authors
Eman Sbaity
Hani Tamim
Ghada El-Hajj Fuleihan
Jaber Abbas
Mariam Zahwe
Razan El Sayed
Ali Shamseddine
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-024-11910-w

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