Younger Breast Cancer Patients Face Higher Recurrence Risk

TOPLINE: 
A new study suggests that age is an independent risk factor for late distant recurrence among younger patients with ER-positive, ERBB2-negative breast cancer. In the analysis, patients aged 21-35 years had the lowest rates of locoregional recurrence-free survival, disease-free survival, and late distant-metastasis-free survival compared with patients aged 36-45. 
METHODOLOGY:
Young patients with breast cancer with ER-positive, ERBB2-negative tumors tend to have worse survival outcomes, but there are limited data on the risk for recurrence, specifically late distant recurrence after 5 years, in this population.
In the current retrospective cohort study, researchers assessed 2772 patients aged 21-45 years with ER-positive, ERBB2-negative breast cancer who had no distant recurrence within 5 years following surgery.
Patients were categorized into three age groups based on their age at diagnosis: 21-35 years (n = 370), 36-40 years (n = 885), and 41-45 years (n = 1517). The clinicopathological characteristics and oncologic outcomes were compared across these groups.
The primary outcome was late distant recurrence. The median follow-up duration was 10.8 years.
All patients received adjuvant endocrine therapy for at least 2 years; 90% underwent therapy for 5 years or more, while 10% completed 2-5 years of therapy. A higher proportion of patients in the youngest group (15.9%) received less than 5 years of endocrine therapy compared with those in the older groups (7.9% among those aged 36-40 years and 7.4% among those aged 41-45 years). 
TAKEAWAY:
Compared with patients in the two older age groups, the youngest patients (aged 21-35) had worse 10-year rates of locoregional recurrence-free survival (90.1% vs 94.6% for ages 36-40 and 97.7% for ages 41-45), disease-free survival (79.3% vs 88.7% and 94.4%, respectively), and overall survival (96.9% vs 98.2% and 98.9%, respectively).
Similarly, at 10 years, the youngest patients had the lowest rates for late distant metastasis-free survival (89.3%) compared with patients aged 36-40 years (94.2%) and those aged 41-45 years (97.2%).
Compared with the youngest group, the risk for late distant recurrence was 47% lower in patients aged 36-40 years (adjusted hazard ratio [aHR], 0.53; P = .001) and 70% lower in those aged 41-45 years (aHR, 0.30; P < .001). Each 1-year increase in age at breast cancer diagnosis was associated with a 9% lower risk for late distant recurrence (aHR, 0.91; P < .001).
Overall, the findings suggest that younger age was “a significant independent factor” associated with locoregional recurrence-free survival, disease-free survival, and late distant metastasis-free survival, but not overall survival.
IN PRACTICE:
The study findings suggest that “younger patients, particularly those 35 years or younger, exhibited worse oncologic outcomes compared with older groups” and that “younger age was an independent factor associated with late [distant recurrence],” the authors wrote. The results provided insights for improving management of young patients with breast cancer as well as a “need for age-specific treatment approaches,” such as extended endocrine therapy or addition of ovarian function suppression in younger patients with high-risk disease.
SOURCE:
The study, led by Dong Seung Shin, MD, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, was published online in JAMA Network Open. 
LIMITATIONS:
This retrospective analysis was conducted in a single country and focused on a single race, which could limit the generalizability of the findings. Lack of detailed data on the duration of ovarian function suppression and the limited number of patients receiving ovarian suppression therapy could affect the findings. Additionally, the youngest group had a higher proportion of patients who received less than 5 years of endocrine therapy.
DISCLOSURES:
This study was supported by grants from the National Research & Development Program for Cancer Control and by the Institution of Quality of Life in Cancer. Additional funding was provided by a general clinical research grant-in-aid from the Seoul Metropolitan Government Seoul National University Boramae Medical Center. Several authors reported receiving grants or personal fees or having other ties with various sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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