Factors influencing the effect of age on prognosis in breast cancer: population based study
All young women under the age of 35 years with breast cancer should be regarded as high risk patients and be offered chemotherapy after surgery (adjuvant cytotoxic treatment), say researchers from Denmark in this week's BMJ.
Dr Niels Kroman from the Danish Epidemiology Science Centre along with colleagues from Copenhagen studied the treatment and outcome of 10,356 women with breast cancer who were less than 50 years old at the time of their diagnosis. They found that overall, young women who were diagnosed with 'low risk' breast cancers [as classified by the authors] and who did not receive adjuvant treatment, had a significantly increased risk of dying as compared to middle-aged women with 'low risk' breast cancer. The risk, they report, increases the younger the patients' age at diagnosis (women under the age of 35 who hadn't received adjuvant treatment were more than twice as likely to die as women aged 45 to 49 years at diagnosis).
The authors say that the negative effect of young age on a woman's prognosis of breast cancer (a phenomenon which has been reported in previous studies) seems to only be true among those women who have not received adjuvant cytotoxic treatment. Among women who received this therapy, age did not have a significant effect on prognosis, say Kroman et al.
They say that their results cannot be taken as direct evidence that young patients with low risk disease will benefit from adjuvant cytotoxic treatment, however, based on other recent research they are confident that low risk tumours will respond well to such treatment, leading to a better prognosis for this group of women.
Kroman et al conclude that young women with breast cancer, on the basis of age alone, should be regarded as high risk patients and be given adjuvant cytotoxic treatment.
Contact:
Professor Mads Melbye, Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark
Email: mme@ssi.dk