Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India. (December 2021)

• Record Type: Journal Article
• Authors: Bajpai, Jyoti; Ventrapati, Pradeep; Joshi, Shalaka; Wadasadawala, Tabassum; Rath, Sushmita; Pathak, Rima; Nandhana, Ravindra; Mohanty, Samarpita; Chougle, Qurratulain; Engineer, Mitchelle; Abraham, Nissie; Ghosh, Jaya; Nair, Nita; Gulia, Seema; Popat, Palak; A, Patil; Sheth, Tanuja; Desai, Sangeeta; Thakur, Meenakshi; Rangrajan, Venkatesh; Parmar, Vani; Sarin, R.; Gupta, S.; Badwe, R.A.
• Is Part Of: Breast. Volume 60(2021)
• Page Start: 177
• Page End: 184
• Publication Date: 2021-12
• Subjects: Young breast cancer -- Chemotherapy -- Outcomes -- Fertility -- Quality of life; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2021.09.008
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. Methods: The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. Results: There were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. Conclusion: More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus. Highlights: Largest data of young breast cancer from India analysing demographics, outcomes and fertility. Higher proportion of YBC with advanced stage and aggressive features compared to western data. Inferior survival in HER-2+ not receiving Trastuzumab, need access of life saving drugs to all. Scope of improvement and collaboration in challenges like fertility, pregnancy and quality of life.