BREAST-CANCER IN ADOLESCENT FEMALES

Reports of breast cancer in adolescent females consist mostly of isola ted patients. Because of this, neither the prognosis nor optimal manag ement of the disease in this age group is clear. The authors retrospec tively reviewed their 40-year single institution experience of all pat ients under 20 years of age who were referred for treatment of newly d iagnosed breast cancer. The charts of 16 patients, all females (age ra nge, 13 to 19 years), were reviewed. Four patients found to have cytos arcoma phyllodes and two with tumors metastatic to the breast were exc luded from further study. Ten patients had various forms of adenocarci noma of the breast, including invasive intraductal, invasive lobular, signet ring, and secretory adenocarcinoma. Four had a family history o f breast cancer. The average time from onset of symptoms to diagnosis was 3.7 months. Mammography failed to diagnose cancer in any of the fo ur patients tested, including one with an 8-cm mass. Two patients had stage I tumors, four had stage IIA, two had stage IIIA, and two had st age IV. The patients were treated with combinations of surgery, radiat ion therapy, and chemotherapy. One stage I patient (with bilateral bre ast cancer) died of radiation-induced sarcoma after treatment; the oth er stage I patient is alive without disease 15 years after treatment. The 5-year survival rate for stage IIA patients was 50%; that for pati ents with stage IIIA or IV was 0%. Five of the 10 patients presented d uring the past 10 years. This study constitutes the largest single ins titution experience with adolescent breast cancer. Adenocarcinoma of t he breast, although rare, does occur in adolescent females and must be considered in the differential diagnosis of breast masses in this age group. Appropriate evaluation may necessitate biopsy because mammogra phy can be unreliable, The outcome for our patients suggests that the prognosis of advanced stage breast cancer in adolescents may be at lea st as ominous as that in adult patients. Since several advanced-stage patients presented with large (<5 cm) tumors or had a long delay (up t o 13 months) between onset of symptoms and diagnosis, thor ough evalua tion of a breast mass in an adolescent female should not be postponed. Copyright (C) 1995 by W.B. Saunders Company