Breast Cancer in Young Women Arrow Project June 6 th Aharona Gutman Dr. Shani Paluch-Shimon
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1 Breast Cancer in Young Women Arrow Project June 6 th 2013 Aharona Gutman Dr. Shani Paluch-Shimon
2 Overview - Breast Cancer in Young Women 10% of breast cancers are diagnosed in women under 40 Breast cancer is the leading cause of death amongst women under 45 in the Western world and is a major cause of morbidity Only 30% of breast cancers in women under 40 are caused by known genetic mutations unlike in older women we don t know what causes breast cancer in most young women
3 Breast cancer in young women is a challenge! It is rare. Paucity of modifiable risk factors. Lack of screening. Fertility issues are unique to this group
4 Breast Cancer in Young Women Breast cancer in young women strikes them at the peak of: - Their careers - Their reproductive years - Their motherhood and most active years of family life
5 Age-Specific Probabilities of Developing Breast Cancer By age 30 1:1985 By age 40 1:229 By age 50 1:68 By age 60 1:37 By age 70 1:26 By age 80 1:24 By lifetime 1:8 (ACS Research, SEER 2005)
6 Ten leading causes of death in women aged by country income group, 2004 Women & Health, WHO Report, 2009
7 Ten leading causes of death in women aged by country income group, 2004 Women & Health, WHO Report, 2009
8
9 WHAT CAUSES BREAST CANCER IN YOUNG WOMEN?
10 Major Breast Cancer Risk Factors GENDER AGE ATYPICAL HYPERPLASIA / LCIS FAMILY HISTORY Unknown Ca Dx d 70 y Colon Ca Dx d 50 y Dx d 45 y Br Ca Dx d 28y Ov Ca Dx d 33y Dx d 30y Dx d 38y Dx d 39y Dx d 53y
11 Family history is not enough
12 Proven Risk factors for Early Onset Breast Cancer Birth weight, growth rate in childhood, attained height effects are small. High BMI is protective against breast cancer in premenopausal. Oral contraceptives actual risk increase is small. Breastfeeding is protective- more modest effect in premenopausal. Increasing parity the effect is less protective in young women. Exposure to ionizing radiation (depends on the age of exposure and the radiation dose.) relative risk is higher for early onset BC <35. Genetic factors.
13 WHAT S DIFFERENT ABOUT BREAST CANCER IN YOUNG WOMEN?
14 TNM STAGING Primary tumor (T) Regional lymph nodes (N) clinical/pathologic Distant metastasis (M)
15 Pathological stage according to TNM (ptnm), tumor size and degree of axillary node involvement as a percentage of the respective age cohorts by Oxford University Press Colleoni M et al. Ann Oncol 2002;13:
16 Expression of ERs, PgRs, presence of peritumoral VI, grading (G), expression of Ki-67, overexpression of HER2/neu, as percentage of the respective age cohorts by Oxford University Press Colleoni M et al. Ann Oncol 2002;13:
17 Association between very young age and adverse characteristics of breast cancer at presentation amongst Israeli women Of 1448 newly diagnosed breast cancer patients Sixty-one very young (<35) and 94 less-young (40-50) patients were identified. Significantly more very young patients had metastatic disease at presentation (20% vs. 3%, respectively, P = ). The very young patients were more likely to have high grade, HR- tumors than the less young patients. After controlling for stage and tumor grade, very-young age was not shown to be an independent risk factor for reduced survival. Paluch-Shimon S. Am J Clin Oncol 2011
18 Survival by age Jayasinghe ANZ J Surg. 2005
19 Disease Free Survival by Age Only women over 80 do worse
20 Other issues: Early onset menopause Fertility preservation Sexual disfunction Pregnancy after breast cancer Psycho-social issues
21 Ongoing studies
22 Objective Little research performed specifically on breast cancer in young women Age as an independent risk factor Conclusions regarding screening, prognosis & treatment
23 Method - Clinical data base Data abstraction 200 young patients descriptive analysis
24 Data abstraction is fun!
25
26 Goals Characterization of breast cancer in young women before treatment Mode of diagnosis Shown on mammography Shown on ultrasound Shown on MRI TNM Stage Estrogen Progesteron Her-2 Family history (cancer) Family history (breast cancer) Genetics 40 < 50 >
27 Goals Characterization of breast cancer in young women - before treatment Mode of diagnosis Shown on mammography Shown on ultrasound Shown on MRI TNM Stage Estrogen Progesteron Her-2 Family history (cancer) Family history (breast cancer) Genetics??? 40 < 50 >
28 Goals Assessing treatment effectiveness example: Relumpectomy Age as an independent risk factor for bad prognosis (stage per stage) Long term outcome
29 Method prospective study International study Dana-Farber Epidemiological questioners
30 Goals Etiology - Risk factors Psychosocial effects Quality of life - Treatment side effects Clinical character
31 Method prospective study Genetic epidemiological study New mutations in young women Genetic data base
32 May 2013 December 2013 June Timeline: Prospective international study Data analysis clinical data base Genetic data base
33 Thank you!
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