Breast Cancer in Young Women – Correlation of Clinical Histomorphological, and Molecular-genetic Features of Breast Carcinoma in Women Younger than 35 Years of Age

Česká verzia

Authors: A. Metelková ¹; A. Skálová ^2,3; J. Fínek ¹
Authors place of work: Onkologická a radioterapeutická klinika LF UK a FN Plzeň ¹; Šiklův ústav patologie, LF UK a FN Plzeň ²; Bioptická laboratoř s. r. o., Plzeň ³
Published in the journal: Klin Onkol 2017; 30(3): 202-209
Category: Original Articles
doi: https://doi.org/10.14735/amko2017202

Summary

Background:
Worldwide, breast cancer is the leading type of malignancy in women. For premenopausal women, the disease brings much higher risk as it is usually more aggressive with worse prognosis.

Patients and Methods:
In this retrospective study, 92 women treated at the Department of Oncology and Radiotherapy in Pilsen were selected from a basic cohort of 356 women under 35 years of age with breast cancer who were diagnosed between 2006 and 2015. The control group comprised 100 postmenopausal women over 65 years of age who were treated for invasive breast cancer.

Results:
Overexpression of HER2/neu protein and a triple-negative immunoprofile and basal-like phenotype of cancer were more frequently seen in the women under 35 years of age. In addition, malignant cells were poorly differentiated and more aggressive, and prognostically favourable types were not often seen, in these women. In terms of the course of disease, the outcome was worse for the younger patients, and complete remission was reached less frequently and more cases of advanced disease and death due to the malignancy were detected.

Conclusion:
The incidence of invasive breast cancer in young women is low, representing around 2% of all cases of the disease, but this group of patients is prognostically very important. The cancers at such a young age are usually more aggressive (higher mitotic activity and higher grade), and prognostically worse types, such as triple-negative or basal-like, are seen significantly more often in younger patients. This retrospective study confirmed this premise. Moreover, breast cancer in young women is more often associated with genetic predisposition (e. g., hereditary mutations in BRCA1 and BRCA2 genes) than in older women.

Key words:
breast cancer – young women – triple negative breast cancer – BRCA mutation – basal-like – tumor-suppressor genes

This work was partially supported by the Charles University research fund (project number SVV-2016-260 282).

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted:
10. 1. 2017

Accepted:
15. 3. 2017

Zdroje

1. Svod.cz [internetová stránka]. Databáze Národního onkologického registru. [cited 2017 Dec 20]. Dostupný z: http: //www.svod.cz.

2. Nová J, Palácová M, Forejtová L et al. Zhoubná nádorová onemocnění prsu u mladých žen v České republice 1989–2004. Klin Onkol 2008; 21 (1): 35–36.

3. Chung M, Chang HR, Bland KI et al. Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 1996; 77 (1): 97–103.

4. Dubsky PF, Gnant MF, Taucher S et al. Young age as an independent adverse prognostic factor in premmenopausal patients with breast cancer. Clin Breast Cancer 2002; 3 (1): 65–72.

5. Shannon C, Smith IE. Breast cancer in adolescent and young women. Eur J Cancer 2003; 39 (18): 2632–2642.

6. De La Rochefordiere A, Asselain B, Campana F et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet 1993; 341 (8852): 1039–1043.

7. Fowble BL, Schultz DJ, Overmoyer B et al. The influence of young age on outcome in early stage breast cancer. Int J Radiation Oncol Biol Phys 1994; 30 (1): 23–33.

8. Anders CK, Hsu DS, Broadwater G et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 2008; 26 (20): 3324–3330. doi: 10.1200/JCO.2007.14.2471.

9. El Saghir NS, Seoud M, Khalil MK et al. Effects of young age at presentation on survival in breast cancer. BMC Cancer 2006; 6: 194.

10. Golshan M, Miron A, Nixon AJ et al. The prevalence of germeline BRCA1 and BRCA2 mutations in young women with breast cancer undergoing breast-conservation therapy. Am J Surg 2006; 192 (1): 58–62.

11. Lakhani SR, Reis-Filho JS, Fulford L et al. Prediction of BRCA1 status in patients with breast cancer using estrogen receptor and basal phenotype. Clin Cancer Res 2005; 11 (14): 5175–5180.

12. Bori R, Cserni G. Basal phenotype in breast carcinoma occurring in women aged 35 or younger. Pathol Oncol Res 2009; 15 (1): 41–45.

13. Fínek J, Holubec L Jr., Topolcan O et al. The importance of prognostic factors in premenopausal women with breast cancer. Anticancer Res 2007; 27 (4A): 1893–1896.

14. Wolff AC, Hammond ME, Hicks DG et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 2013; 31 (31): 3997–4013. doi: 10.1200/JCO.2013.50. 9984.

15. Shah MV, Wiktor AE, Meyeer RG et al. Change in Pattern of HER2 Fluorescent in Situ Hybridization (FISH) Results in Breast Cancers Submitted for FISH Testing: Experience of a Reference Laboratory Using US Food and Drug Administration Criteria and American Society of Clinical Oncology and College of American Pathologists Guidelines. J Clin Oncol 2016. pii: JCO618983. In press.

16. Wolff AC, Hammond EH, Hicks DG et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer. American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med 2014; 138 (2): 241–256. doi: 10.5858/arpa.2013-09 53-SA.

17. Hammond ME, Hayes DF, Dowsett M et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 2010; 28 (16): 2784–2795. doi: 10.1200/JCO.2009.25. 6529.

18. Hammond ME, Hayes DF, Dowsett M et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med 2010; 134: E1–E16.

19. Kinkor Z, Grossman P, Skálová A. Molekulární testování HER2 u karcinomu prsu jako kritérium výběru nemocných k léčbě Herceptinem – jsme optimální? Breast Cancer News 2014; 4 (2): 10–13.

20. Nielsen TO, Hsu DD, Jensen K et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Research 2004; 10 (16): 5367–5374.

21. Di Palma S, Simpson RH, Marchio C et al. Salivar duct carcinomas can be classified into luminal androgen receptor-positive, HER2 and basal-like phenotypes. Histopathology 2012; 61 (4): 629–643. doi: 10.1111/j.13652559.2012.04252.x.

22. Perrou CM, Sorie T, Elsen MB et al. Molecular portraits of human breast tumours. Nature 2000; 406 (6797): 747–752.

23. Sotiriou C, Neo SY, McShane LM et al. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci U S A 2003; 100 (18): 10393–10398.

24. Bacchi LM, Corpa M, Santos PP et al. Estrogen receptor-positive breast carcinomas in younger women are different of those of older women: a pathological and immunohistochemical study. Breast 2010; 19 (2): 137–141. doi: 10.1016/j.breast.2010.01.002.

25. Johnson RH, Hu P, Fan C et al. Gene expression in „young adult type“ breast cancer: a retrospective analysis. Oncotarget 2015; 6 (15): 13688–13702.

26. Da Silva L, Lakhani SR. Pathology of hereditary breast cancer. Mod Pathol 2010; 23 (Suppl 2): S46–S51. doi: 10.1038/modpathol.2010.37.

27. Ho-Yen C, Bowen RL, Jones JL. Characterization of basal-like breast cancer: an update. Diagnostic Histopathol 2012; 18: 104–111.

28. Rakha EA, Putti TC, Abd El-Rahim DM et al. Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentitation. J Pathol 2006; 208 (4): 495–506.

29. Reis-Filho JS, Tutt ANJ. Triple negative tumours: a critical review. Histopathology 2008; 52 (1): 108–118. doi: 10.1111/j.1365-2559.2007.02889.x.