Breast Cancer Cases Among Adolescence: Breast Cancer Cases Among Adolescence

Breast cancer is very rare in adolescents and very young women. Less than 1% of all breast cancer cases occur before the age of 30 years (National Cancer Inst Monogram 16 (1994) 69). Invasive breast cancer occurring in women before the age of 35 years has a more aggressive biological behavior and is associated with a worse prognosis than in older pre-menopausal women. Breast cancers in these young women are more frequently poorly differentiated, estrogen-receptor (ER)-negative, have lymph vascular invasion and high proliferating fractions. Breast-conserving surgery in women <35 years old is associated with a higher risk of local recurrence than in older women. All young women should be considered at moderate-high risk by virtue of their age alone and offered adjuvant therapy. The long-term toxicity of adjuvant therapies is a particular concern when treating these women. The implications of possible fertility impairment and premature menopause require consideration when discussing adjuvant chemotherapy and endocrine therapy. Adolescents and young women are particularly vulnerable to emotional distress and psychosocial problems and should be provided with appropriate support.

Reports of breast cancer in adolescent females consist mostly of isolated patients. Because of this, neither the prognosis nor optimal management of the disease in this age group is clear. The authors retrospectively reviewed their 40-year single-institution experience of all patients under 20 years of age who were referred for treatment of newly diagnosed breast cancer. The charts of 16 patients, all females (age range, 13 to 19 years), were reviewed. Four patients found to have cytosarcoma phyllodes and two with tumors metastasis to the breast were excluded from further study. Ten patients had various forms of adenocarcinoma of the breast, including invasive intraductal, invasive lobular, signet ring, and secretary adenocarcinoma. Four had a family history of breast cancer. The average time from onset of symptoms to diagnosis was 3.7 months. Mammography failed to diagnose cancer in any of the four 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 stage IV. The patients were treated with combinations of surgery, radiation therapy, and chemotherapy. One stage I patient (with bilateral breast cancer) died of radiation-induced sarcoma after treatment; the other stage I patient is alive without disease 15 years after treatment. The 5-year survival rate for stage IIA patients was 50%; that for patients with stage IIIA or IV was 0%. Five of the 10 patients presented during the past 10 years. This study constitutes the largest single institution experience with adolescent breast cancer.

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1 comment:

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