Clinicopathological Characteristics And Treatment Outcomes Of Breast Cancer Among Adolescents And Young Adults In A Developing Country
Received 5 September 2019
Accepted for publication 18 October 2019
Published 22 November 2019 Volume 2019:11 Pages 9891—9897
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Chien-Feng Li
Hikmat Abdel-Razeq,1,2 Hanan Almasri,3 Fadwa Abdel Rahman,3 Hazem Abdulelah,1 Mahmoud Abu Nasser,1 Mourad Salam,1 Ammer Al-Dairi,3 Osama Natour,4 Dalia Rimawi5
1Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan; 2School of Medicine, University of Jordan, Amman, Jordan; 3Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan; 4Department of Surgery, King Hussein Cancer Center, Amman, Jordan; 5Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
Correspondence: Hikmat Abdel-Razeq
Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman 11941, Jordan Tel +962 6 530 0460 Ext 1000
Purpose: Compared to Western societies, breast cancer diagnosis in our region is usually made at a younger age and at a more advanced stage. Breast cancer in younger patients tends to be more aggressive, and may result in a higher likelihood of long-term treatment-related toxicity and unique psychosocial problems. This study highlights the clinicopathological features and treatment outcomes in this age-group in a developing country like ours.
Methods: Consecutive patients aged 40 years or younger with a pathologically confirmed diagnosis of breast cancer treated and followed up at our institution were included. Medical records and hospital databases were searched for patients’ characteristics and treatment outcomes.
Results: A total of 417 patients were enrolled. Median age at diagnosis was 35 (21–40) years. On presentation, 63 (15.1%) patients had metastatic disease, 50 (79.4%) with visceral metastasis. Patients with nonmetastatic disease had poor pathological features, including node-positivity (66.9%), grade III (51.4%), lymphovascular invasion (48.6%) and positive HER2 (31.5%). Breast-conserving surgery was performed on 32.9%, and only 36.5% of women had breast-reconstruction surgery. At a median follow-up of 59 months, 5-year overall survival for the whole group was 72%: 84% for nonmetastatic and 13% for those with metastatic disease. On Cox regression, nodal metastasis (adjusted HR 3.46, 95% CI 1.48–8.10; p=0.004) and grade III disease (HR 1.97, 95% CI 1.14–3.39; p=0.015) were associated with poor outcome.
Conclusion: Adolescents and young Jordanian adults with breast cancer present with more advanced–stage disease and more aggressive pathological features that reflect poorly on treatment outcomes.
Keywords: breast cancer, adolescents and young adults, AYA, developing countries, late presentation
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