THE INFLUENCE OF YOUNG AGE ON OUTCOME IN EARLY-STAGE BREAST-CANCER

Purpose: To assess the impact of young age on outcome in women with ea rly stage breast cancer undergoing conservative surgery and radiation. Methods and Materials: Between 1981 and 1991, 980 patients with Stage I and II breast cancer underwent excisional biopsy, axillary dissecti on, and radiation. The median follow-up was 4.6 years, with a range of I month to 11 years. The patients were divided into three groups, bas ed on age at the time of diagnosis: (a) age less than or equal to 35 y ears-64 patients, (b) age 36-50 years-363 patients, and (c) age greate r than or equal to 50 years-553 patients. The comparability of the gro ups was assessed in terms of clinical factors (tumor size and race), h istopathologic factors (histologic subtype, final resection margin, es trogen and progesterone receptor status, pathologic nodal status), and treatment related factors (reexcision, median total dose to the prima ry, region(s) treated with radiation, and the use of adjuvant systemic chemotherapy and/or tamoxifen). Outcome was evaluated for overall, re lapse-free, and cause-specific survival and patterns of first failure (breast, regional nodes, and distant metastasis). Results: There were no significant differences among the three groups in terms of race, cl inical tumor size, pathology of the primary tumor, pathologic nodal st atus, final margin of resection, progesterone receptor status, median total dose to the primary tumor, or the regions treated. However, youn ger women were significantly more likely to have estrogen receptor neg ative tumors, undergo reexcision, and receive adjuvant systemic chemot herapy without tamoxifen. Younger women were found to have a statistic ally significantly decreased 8-year actuarial relapse-free survival (5 3% vs. 67% vs. 74%, p = 0.009), cause-specific survival (73% vs. 84% v s. 90%, p = 0.02), freedom from distant metastasis (76% vs. 75% vs. 83 %, p = 0.02), and a significantly increased risk of breast recurrence (24% vs. 14% vs. 12%, p = 0.001), and regional node recurrence (7% vs. 1% vs. 1%, p = 0.0002). The patients were further divided on the basi s of their pathologic nodal status. There were no statistically signif icant differences among the three age groups for axillary node-positiv e patients for overall survival (75% vs. 80% vs. 74%), relapse-free su rvival (73% vs. 73% vs. 62%), cause-specific survival (76% vs. 85% vs. 80%), and freedom from distant metastasis (75% vs. 75% vs. 72%), or b reast recurrence (0% vs. 9% vs. 6%). The findings were identical when the analysis was restricted to node-positive patients who received che motherapy. However, for axillary node-negative women, young age was as sociated with a statistically significant decreased overall survival(7 1% vs. 83% vs. 92%), relapse-free survival (51% vs. 65% vs. 76%), caus e-specific survival(71% vs. 86% vs. 93%), freedom from distant metasta sis (77% vs. 76% vs. 88%), and a statistically significant increased r isk of breast recurrence (40% vs. 16% vs.13%), and regional node recur rence (3% vs. 1% vs. 0%). The risk of a breast recurrence in axillary node-negative young women was decreased by the addition of adjuvant sy stemic chemotherapy but not by the use of reexcision. Conclusions: The present analysis demonstrates that young women with early stage breas t cancer do significantly worse when compared to older women in terms of relapse-free survival, cause-specific survival, distant metastasis and breast and regional node recurrence. However, the adverse effect o f young age on outcome appears to be limited to the node-negative pati ents. These findings suggest that node-negative early stage breast can cer in young women is a more aggressive disease, with an increased ris k for all patterns of failure and a decreased survival.