Multifocal breast cancer in women ≤35 years old

BACKGROUND. The relation that multifocality at diagnosis had to survival in women <35 years of age was evaluated. METHODS. Three hundred women seen at the M. D. Anderson Cancer Center between 1990 and 2002 were identified. Multifocality was defined as the presence of 2 or more foci of the same tumor clearly separated in the same breast. Patient characteristics and outcomes were tabulated and compared between uni- and multifocality. Survival outcomes were estimated with the Kaplan-Meier product limit method and compared between groups with the log-rank statistic. Cox proportional hazards models were fit to determine the association between multifocality and survival outcomes. RESULTS. The median age was 32 years (range, 17-35). There were 58 patients (19%) with multifocal disease. At a median follow-up of 43.9 months there have been 101 deaths and 138 recurrences. Five-year overall survival (OS) estimates were 69.7% (95% confidence interval [CI], 63.1%, 77.1%) for patients with unifocal disease and 67.3% (95% CI, 54.6%, 83.0%) for patients with multifocal disease (P = .70). Five-year recurrence-free survival (RFS) was 44.4% (95% CI, 37.1%, 53.2%) for patients with unifocal disease and 57.1% (5% CI, 43.3%, 75.4%) for patients with multifocal disease, (P = .36). Nuclear grade was found to be an independent predictor of OS and RFS (hazard ratio [HR], 2.92, 95% CI, 1.24-6.87; HR, 2.09, 95% CI, 1.13-3.83, respectively). CONCLUSIONS. Multifocality does not appear to influence prognosis in patients < 35 years of age. Nuclear grade continues to be an important prognostic factor for breast cancer in this age group.