The relationship between age of disease onset and prognosis of breast cancer in women

Document Type : Original Article

Authors

1 Assistant professor, Department of Plastic Surgery, Research Center for Noncommunicable Diseases, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

2 General practitioner, Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

3 Instructor, Department of Anesthesiology, Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

4 Fellowship of Breast Diseases, Research Center for Noncommunicable Diseases, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

Abstract

Introduction: Breast cancer is the most common type of cancer and the second leading cause of cancer death in women. The severity and importance of risk factors and predisposing behaviors are different in each region. Analysis of the relationship between prognostic factors in women with breast cancer can affect the treatment process of patients. The present study was performed with aim to investigate the relationship between age of disease onset and the prognosis of breast cancer in women.
Methods: This cross-sectional descriptive study was performed on 160 patients referred to Khatam Al-Anbia Cancer Clinic in Jahrom in 2021 and their cancer was confirmed based on pathology report. The information in the questionnaire was analyzed using patients' files. Data were analyzed by SPSS software (version 21) and Spearman's correlation coefficient test and survival analysis and Kaplan-Meier curve (survival). P<0.05 was considered statistically significant.
Results: There was no statistically significant relationship between age of disease onset and stage of breast cancer (r = 0.018, P = 0.891) and the size of lesions at the time of breast cancer diagnosis (r = 0.031, P = 0.721). Spearman correlation coefficient showed that there was a statistically significant relationship between the age of disease onset and lymph node involvement (r = -0.190, P = 0.016) and the prognostic factor Her2 at the time of breast cancer diagnosis (r = -0.167, P = 0.045); as the age of onset increases, Her2 decreases at the time of breast cancer diagnosis.
Conclusion: The highest frequency of age of women participating in the study was in the range of 41 to 50 years, but according to survival analysis based on age group, survival was higher in people over 70 years than other age groups (4.71±0.54 years). However, the Kaplan Mir chart did not show a difference between the different age groups, but as age increases, Her2 and lymph node involvement decreases at the time of breast cancer diagnosis.

Keywords


  1. American Cancer Society. Breast Cancer Facts & Figs 2015–2016. Atlanta: American Cancer Society Inc; 2015.
  2. Howlader NN, Noone AM, Krapcho ME, Miller D, Brest A, Yu ME, et al. SEER cancer statistics review, 1975–2016. National Cancer Institute 2019; 1.
  3. Tamimi RM, Spiegelman D, Smith-Warner SA, Wang M, Pazaris M, Willett WC, et al. Population attributable risk of modifiable and nonmodifiable breast cancer risk factors in postmenopausal breast cancer. American journal of epidemiology 2016; 184(12):884-93.
  4. Dall GV, Britt KL. Estrogen effects on the mammary gland in early and late life and breast cancer risk. Frontiers in oncology 2017; 7:110.
  5. Shiyanbola OO, Arao RF, Miglioretti DL, Sprague BL, Hampton JM, Stout NK, et al. Emerging Trends in Family History of Breast Cancer and Associated RiskTrends in Family History of Breast Cancer. Cancer epidemiology, biomarkers & prevention 2017; 26(12):1753-60.
  6. Kharazmi E, Chen T, Narod S, Sundquist K, Hemminki K. Effect of multiplicity, laterality, and age at onset of breast cancer on familial risk of breast cancer: a nationwide prospective cohort study. Breast cancer research and treatment 2014; 144(1):185-92.
  7. DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA: a cancer journal for clinicians 2011; 61(6):408-18.
  8. Bouchardy C, Fioretta G, Verkooijen HM, Vlastos G, Schaefer P, Delaloye JF, et al. Recent increase of breast cancer incidence among women under the age of forty. British journal of cancer 2007; 96(11):1743-6.
  9. Dobi Á, Kelemen G, Kaizer L, Weiczner R, Thurzó L, Kahán Z. Breast cancer under 40 years of age: increasing number and worse prognosis. Pathology & Oncology Research 2011; 17(2):425-8.
  10. 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.
  11. Ibrahim A, Salem MA, Hassan R. Outcome of young age at diagnosis of breast cancer in South Egypt. Gulf J Oncolog 2014; 1(15):76-83.
  12. Cvetanovic A, Popovic L, Filipovic S, Trifunovic J, Zivkovic N, Matovina-Brko G, et al. Young age and pathological features predict breast cancer outcome-report from a dual Institution experience in Serbia. J buon 2015; 20(6):1407-13.
  13. Alieldin NH, Abo-Elazm OM, Bilal D, Salem SE, Gouda E, Elmongy M, et al. Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?. Journal of the Egyptian National Cancer Institute 2014; 26(1):23-30.
  14. Cluze C, Colonna M, Remontet L, Poncet F, Sellier E, Seigneurin A, et al. Analysis of the effect of age on the prognosis of breast cancer. Breast cancer research and treatment 2009; 117(1):121-9.
  15. Brandt J, Garne JP, Tengrup I, Manjer J. Age at diagnosis in relation to survival following breast cancer: a cohort study. World journal of surgical oncology 2015; 13(1):1-11.
  16. Wei XQ, Li X, Xin XJ, Tong ZS, Zhang S. Clinical features and survival analysis of very young (age< 35) breast cancer patients. Asian Pacific Journal of Cancer Prevention 2013; 14(10):5949-52.
  17. Vostakolaei FA, Broeders MJ, Rostami N, Van Dijck JA, Feuth T, Kiemeney LA, et al. Age at diagnosis and breast cancer survival in iran. International journal of breast cancer 2012; 2012.
  18. Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. Journal of Clinical Oncology 2010; 28(12):2038.
  19. Deger A, Ozyigit F, Arik O, Ekici F, Cinkaya A, Tayfur M, et al. Association between well-known histopathological criteria and overall survival in invasive ductal carcinoma. International journal of clinical and experimental pathology 2015; 8(9):9772-81.
  20. An YY, Kim SH, Kang BJ, Park CS, Jung NY, Kim JY. Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes. European journal of radiology 2015; 84(10):1894-902.
  21. Jalali MR, Jaseb K, Valaie N. Relationship between age, histological malignancy and prognosis of patients with breast cancer. Feyz 2002; 5(4):68-73.
  22. Sun LJ, Oh M. Reproductive factors and subtypes of breast cancer defined by ER, PR, and HER-2: a register-based study from Korea. Clinical Breast Cancer 2014:1-21.
  23. de Kruijf EM, Bastiaannet E, Rubertá F, de Craen AJ, Kuppen PJ, Smit VT, et al. Comparison of frequencies and prognostic effect of molecular subtypes between young and elderly breast cancer patients. Molecular oncology 2014; 8(5):1014-25.
  24. Alteri R, Barnes C, Burke A, Gansler T, Gapstur S, Gaudet M, et al. Breast cancer facts & figures 2013-2014. Atlanta: American Cancer Society; 2013.
  25. Narod SA. Breast cancer in young women. Nature reviews Clinical oncology 2012; 9(8):460-70.
  26. Miki Y, Swensen J, Shattuck-Eidens D, Futreal PA, Harshman K, Tavtigian S, et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 1994; 266(5182):66-71.
  27. Wooster R, Bignell G, Lancaster J, Swift S, Seal S, Mangion J, et al. Identification of the breast cancer susceptibility gene BRCA2. Nature 1995; 378(6559):789-92.
  28. Tavtigian SV, Simard J, Rommens J, Couch F, Shattuck-Eidens D, Neuhausen S, et al. The complete BRCA2 gene and mutations in chromosome 13q-linked kindreds. Nature genetics 1996; 12(3):333-7.
  29. Easton DF. How many more breast cancer predisposition genes are there?. Breast Cancer Research 1999; 1(1):1-4.
  30. Campeau PM, Foulkes WD, Tischkowitz MD. Hereditary breast cancer: new genetic developments, new therapeutic avenues. Human genetics 2008; 124(1):31-42.
  31. Ford D, Easton DF, Peto J. Estimates of the gene frequency of BRCA1 and its contribution to breast and ovarian cancer incidence. American journal of human genetics 1995; 57(6):1457-62.
  32. Loibl S, Jackisch C, Lederer B, Untch M, Paepke S, Kümmel S, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast cancer research and treatment 2015; 152(2):377-87.
  33. Chen HL, Zhou MQ, Tian W, Meng KX, He HF. Effect of age on breast cancer patient prognoses: a population-based study using the SEER 18 database. PloS one 2016; 11(10):e0165409.
  34. 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):1-8.
  35. 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. Journal of the American College of surgeons 2009; 208(3):341-7.
  36. Souvizi B, Shahid Sales S, Noferesti GH, Makhdoumi Y, Rezaei Kalat A, Jafarzadeh Esfehani R, et al. Assessment of effective factors on prognosis of breast cancer patients. Iran J Obstet Gynecol Infertil 2017; 19(39):18-24.
  37. Haghighat S. Survival rate and its correlated factors in breast cancer patients referred to Breast Cancer Research Center. Iranian Quarterly Journal of Breast Disease 2013; 6(3):28-36.
  38. Najafi R, Amiri F, Roshanaei Gh, Abbasi M, Razi M. Factors Affecting Survival in Patients with Breast Cancer in Hamedan Province from 2001 to 2018. Iranian Quarterly Journal of Breast Disease 2020; 12(4):31-8.
  39. Mohammadpour M, Yaseri M, Mahmoudi M, Entezar Mahdi R. Estimation of survival in women diagnosed with breast cancer with cure survival in West-Azerbaijan and East-Azerbaijan provinces. Journal of School of Public Health and Institute of Public Health Research 2018; 16(1):63-74.
  40. Karimi A, Moradi Z, Sayehmiri K, Delpisheh A, Sayehmiri F. Investigation of 1 to 10-year survival of breast cancer in Iranian women: A systematic review and meta-analysis. Iran J Obstet Gynecol Infertil 2016; 19(22):17-25.
  41. Atashgar K, Molana SH, Biglarian A, Sheikhaliyan A. Analysis of survival data of patient with breast cancer using Cox regression model. Iranian Journal of surgery 2016; 24(1): 62-76.
  42. Mokarian F, Mokarian S, Ramezani A. Relations of Disease-Free Survival and Overall Survival with Age and Primary Metastases in Patients with Breast Cancer. Journal of Isfahan Medical School 2013; 31(225):112-20.
  43. Vostakolaei FA, Broeders MJ, Rostami N, Van Dijck JA, Feuth T, Kiemeney LA, et al. Age at diagnosis and breast cancer survival in iran. International journal of breast cancer 2012; 2012.
  44. Ikpat OF, Ndoma-Egba R, Collan Y. Influence of age and prognosis of breast cancer in Nigeria. East African medical journal 2002; 79(12):651-7.
  45. Alieldin NH, Abo-Elazm OM, Bilal D, Salem SE, Gouda E, Elmongy M, et al. Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?. Journal of the Egyptian National Cancer Institute 2014; 26(1):23-30.
  46. Crowe JP, Gordon NH, Shenk RR, Zollinger RM, Brumberg DJ, Shuck JM. Age does not predict breast cancer outcome. Archives of surgery 1994; 129(5):483-8.
  47. Roder DM, de Silva P, Zorbas HM, Kollias J, Malycha PL, Pyke CM, et al. Age effects on survival from early breast cancer in clinical settings in Australia. ANZ journal of surgery 2012; 82(7‐8):524-8.
  48. Brandt J, Garne JP, Tengrup I, Manjer J. Age at diagnosis in relation to survival following breast cancer: a cohort study. World journal of surgical oncology 2015; 13(1):1-1.
  49. Dobi Á, Kelemen G, Kaizer L, Weiczner R, Thurzó L, Kahán Z. Breast cancer under 40 years of age: increasing number and worse prognosis. Pathology & Oncology Research 2011; 17(2):425-8.
  50. Ibrahim A, Salem MA, Hassan R. Outcome of young age at diagnosis of breast cancer in South Egypt. Gulf J Oncolog 2014; 1(15):76-83.
  51. Alieldin NH, Abo-Elazm OM, Bilal D, Salem SE, Gouda E, Elmongy M, et al. Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?. Journal of the Egyptian National Cancer Institute 2014; 26(1):23-30.
  52. Ali AM, Greenberg D, Wishart GC, Pharoah P. Patient and tumour characteristics, management, and age-specific survival in women with breast cancer in the East of England. British journal of cancer 2011; 104(4):564-70.
  53. Jain M, Miller AB. Tumor characteristics and survival of breast cancer patients in relation to premorbid diet and body size. Breast cancer research and treatment 1997; 42(1):43-55.
  54. 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.
  55. Van De Vijver MJ, He YD, Van't Veer LJ, Dai H, Hart AA, Voskuil DW, et al. A gene-expression signature as a predictor of survival in breast cancer. New England Journal of Medicine 2002; 347(25):1999-2009.
  56. Zabicki K, Colbert JA, Dominguez FJ, Gadd MA, Hughes KS, Jones JL, et al. Breast cancer diagnosis in women≤ 40 versus 50 to 60 years: increasing size and stage disparity compared with older women over time. Annals of surgical oncology 2006; 13(8):1072-7.
  57. 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. Journal of clinical oncology 1994; 12(5):888-94.
  58. Kim JK, Kwak BS, Lee JS, Hong SJ, Kim HJ, Son BH, et al. Do very young Korean breast cancer patients have worse outcomes?. Annals of surgical oncology 2007; 14(12):3385-91.
  59. Kollias J, Elston CW, Ellis IO, Robertson JF, Blamey RW. Early-onset breast cancer–histopathological and prognostic considerations. British journal of cancer 1997; 75(9):1318-23.