Women age < 35 years with primary breast carcinoma: Disease features at presentation

BACKGROUND. The purpose of the current study was to describe a population of young patients with breast carcinoma, their characteristics at the time of diagnosis, and the association of these characteristics with disease recurrence and survival. METHODS. Four hundred fifty-two women age & 35 years with breast carcinoma were registered at The University of Texas M. D. Anderson Cancer Center (Houston, TX) between 1990 and 2002. The relation between clinicopathologic factors and disease recurrence-free survival (RFS) and overall survival (OS) was assessed. Cox regression analysis was used to identify independent survival predictors. RESULTS. The median age of the patients was 32 years. Most of the patients were white, and 20% were obese. Approximately 50% reported oral contraceptive use, 34% reported a family history of breast carcinoma, and 5% reported a family history of ovarian carcinoma. Sixty-nine percent of tumors were nuclear Grade 3 (using the modified Black's nuclear grading system), 52% had positive estrogen receptors, and 48% had positive progesterone receptors. HER-2/neu status was available in 60% of tumor specimens and 34% were HER-2/new positive. The median follow-up was 36 months. There were 185 disease recurrences and 84 deaths. RFS was significantly shorter in patients who reported a family history of ovarian carcinoma (P < 0.0001) and in those who had hormone receptor-negative tumor specimens (P = 0.001). OS was significantly shorter in patients who reported a family history of ovarian carcinoma (P = 0.001), those who had hormone receptor-negative tumor specimens (P < 0.0001), or those with > nuclear Grade 3 tumor specimens (P = 0.005). CONCLUSIONS. This young population with breast carcinoma was found to have more aggressive biologic features. Hormone receptor negativity and a family history of ovarian carcinoma were associated with shorter RFS and OS.