B. Nunez Garcia (Majadahonda, Spain)

Hospital Universitario Puerta de Hierro - (INSALUD)

Author Of 5 Presentations

 On-Demand ePoster Display

133P - Breast Cancer in Young Women (BCYW). Different entity or different needs?

Abstract

Background

Breast cancer is the most common cause of cancer-related deaths in women under 45 years. It has been reported as a more aggressive disease, with worse survival and higher rate of late toxicities in long term survivors, but this population is underrepresented in studies. We designed a study with Real World Data (RWD) focusing on the BCYW population to fill a knowledge gap.

Methods

A retrospective observational study was conducted, including all patients younger than 46 years with a first consultation in the Breast Cancer Unit of the Puerta de Hierro University Hospital between 2009 and 2019. Epidemiological, clinical, pathological and treatment information was collected. We aim to understand the characteristics of our BCYW population with RWD from over a decade of breast cancer care.

Results

559 patients with diagnostic of invasive breast cancer were included. Median age was 41 years (IQR 38 - 44). Population was divided into 3 groups for a better understanding. Patients with previous pregnancy are fewer in the younger subgroup (p<0.000), suggesting the need of fertility counselling. An association is observed between age subgroups and chemotherapy treatment, more likely in the younger subgroup (p=0.008). In <35 years, less stage I, more nodal involvement, triple negative subtype and more mastectomies were described, but without observing any significant association between these and other variables

< 35 years % 35 - <40 years% >= 40 years% All%
n (%) 55 (9,9%) 146 (26,1%) 358 (64%) 559
Pregnancy 59,3 74,1 83,3 78,6
ACO 45,6 33,6% 43 40,8
IMC median (IQR) 21,9 (19,8 – 23,6) 22,6 (20,4 – 24,6) 23,1 (21,2 – 26,6) 22,8 (20,8 – 25,8)
AF breast cancer 34,6 35,6 34,6 34,9
BRCA1/2 positive 10,9 6,2 4,8 5,7
Ductal 90,9 87,7 81,8 84,2
Lobular 5,5 4,8 10,9 8,8
Others 3,6 7,5 7,3 7
I 20 31 36,8 33,6
II 52,7 43,5 37,1 40,3
III 25,5 20 21,1 21,2
IV 1,8 5,5 5 4,9
Nodal involvement + 60 48,6 48,3 49,6
TN 18,5 9,1 11,6 11,6
RRHH+ HER2- 59,3 74,1 72 71,3
RRHH+ HER2+ 18,5 11,2 11,9 12,4
RRHH- HER2+ 3,7 5,6 4,5 4,7
QT (total) 88,9 74,8 69,1 72,6
NEO-QT 32,7 25,3 23,7 25
Mastectomy 79,6 71,7 67,7 70
.

Conclusions

Globally, our BCYW cohort shows a subtype and stage distribution similar to that expected in the general population described in historical records. Although no association was found between the different age groups and most of the clinical or pathological characteristics, the data described for stage I, lymph node involvement, triple negative breast cancer, BRCA mutations and mastectomies in the younger group justify future and deeper research in larger cohorts. We can´t conclude that BCYW is a different entity, but we agree with the mayor consensus that BCYW have different needs and should be studied.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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143P - Fertility rates in Young Breast Cancer Patients (YBCP) and evolution. A new challenge

Abstract

Background

Breast cancer in Young patients (≤45 years) is about 15% of all new diagnosis. At Young age, fertility is often an important issue, especially when there is no offspring. The average age of the first time mothers is increasing in the last years in Spain. A 30% of the Spanish mothers have their first birth older than 35 years old. Pregnancy after breast cancer is still very uncommon.

Methods

A retrospective review of breast cancer patients under 45 years treated at the Oncology department in HUPHM in Madrid-SPAIN between 2009-2019 was performed. The number of pregnancies and births prior to the administration of any treatment was collected. The subgroup of nulliparous patients under 40 years of age who were candidates for fertility preservation was selected and these data have been analyzed.

Results

A total of 555 patients were analysed in the period selected. The number of pregnancies and births in our patients at the moment of diagnosis are described in the table.

<35 years 35-40 >40
No pregnancy 39% (22) 26% (37) 17% (61)
No births 35% (25) 30% (43) 19% (68)
No births or just one 60% (18) 37% (37) 27% (79)
A total of 74 patients under 40 years with no births were evaluated for fertility preservation. 14 patients (20%) were not candidates for fertility preservation due the need of a fast treatment or just local treatment. The selected 60 candidates were handle as follows: 20% refused preservation, 52% (31 Patients) performed oovocyte cryopreservation and the remaining 28% were not offered. Of the total, only 3 pregnancies were obtained, only one per transfer after preservation.

Conclusions

More than 30% of the YBCP ≤40 have no births at the moment of diagnosis. All of them should be referred to a fertility unit and informed about options. Women with just one child might be also informed about options. Very few pregnancies occur after breast cancer diagnosis and this a new challenge with a great area of improvement.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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149P - Restricted mean survival time (RMST): a new tool for time to event analysis in young breast cancer patients (YBCP)

Abstract

Background

Breast cancer (BC) remains the most common malignancy among young female patients and the leading cause of cancer death in this population. BC in young women is a social problem since it often appears during the period of highest family and professional activity. Very often, YBCP are classified as high risk only by age.

Methods

A retrospective analysis of women with BC diagnosed between 2009-2019 in HUPHM in Madrid and ≤ 45 years old at the moment the diagnosis was made. Survival was analyzed according to histopathological subtypes and stages in this population. The Cox proportional hazards model could not be used because our variables could not meet the proportional hazards (PH) assumption. Instead, the RMST at 60 months has been analyzed as an alternative, which means expected survival time subject to a specific time horizon. Kaplan Meier curves were also estimated.

Results

A total of 537 YBCP were analyzed, 104 events were defined (relapse) with a median follow up of 69 months. The patients were divided by histopathological subtypes and stages, and no significant differences were found between stages according to histological subtypes. RMST was clearly diminished independently stage in triple negative and HR-/HER2+ disease (except for stage III due to a low number of subjects). These differences were greater within stage III between triple-negative disease and the other histologies. These results were compared with a Kaplan Meier analysis at 24 and 60 months showing that the risk of relapse was higher in the HR-negative subtypes regardless of HER2 status.

TN RH+/HER2- RH+/HER2+ RH-/HER2+
n 60 357 58 21
Stage (S): n (%) p=.03
I 12 (20%) 144 (40%) 15 (26%) 7 (33%)
II 33 (55%) 141 (39%) 25 (43%) 10 (47%)
III 15 (25%) 72 (20%) 18 (31%) 4 (19%)
Relapses: n (%) 14 (23%) 52 (15%) 7 (12%) 6 (27%)
RMST Expected average survival time within 60 months
S I: Average time (AT) (95%IC) 50,5 (40-61) 59 (58-60) 60 (60-60) 52,6 (39-66)
S II: AT (95%IC) 51,5 (45-57) 57,3 (55-59) 60 (60-60) 55,3 (49-61)
S III: AT (95%IC) 42,3 (30-55) 51,7 (48,1-55) 54,3 (48-60) 56,6 (51-62)
Relapse Free Survival Rate at 24 // 60 months
S I 91%/61,1 % 99%/94% 100%/100% 83,3%/83%
S II 93%/73,9% 97%/87,5% 100%/100% 100%/75%
S III 69%/56% 91%/72% 94%/ 79,3% 100%/66%
All stages 87%/67% 96%/86% 97,9%/92% 90%/73%

Conclusions

The RMST is a valid tool to analyze the risk of relapse according to the tumor biology and the stage at the time of diagnosis, being comparable to the PH in detecting differences between arms when hazards are proportional, but better when they are not.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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174P - Breast screening at young age. A real need?

Abstract

Background

Screening mammography are stablished between the age of 50-69 years in most countries with a few exceptions in those patients with a higher risk (BRCA, Family background…). Breast cancer in patients under 45 is about 15% of all new diagnosis. The clinical impact of treatment is often significant in this particular vulnerable population.

Methods

A retrospective observational study of young breast cancer patients (YBCP ≤45 years old) diagnosed between 2009-2019 in HUPHM was carried out. The main objective was to explore difference between asymptomatic patients (screening) versus symptomatic patients (lump, swelling, pain…). Epidemiological, clinical, pathologic and treatment information was collected.

Results

We analyzed 590 young patients (≤ 45 years old) with a new diagnosis of in situ or infiltrating breast cancer. Results are summarized in the table below.

Asymptomatic Symptomatic univariate analysis, p
N (%) 162 (27%) 428 (73%)
Median age/range 41,9 (26-45) 41,2 (28-45)
Stage 0 (in situ) 20% 5% p=0.001
Stage I 46% 30% p=0.001
Stage II 25% 40% p=0.001
Stage III 6% 20% p=0.001
Stage IV 3% 5% p=0.01
Family background 40% 32% p=0.091
BRCA 1/2 8% 5% p=0.14
Lymph node positive 24% 45% p=0.0001
Mastectomy/Breast conservative 64%/36% 72%/28% p=0.1
Neoadyuvant CT 13% 30% p=0.0001
CT neo or adyuvant 54% 79% p=0.0001
Radiotherapy 31% 54% p=0.0001
Relapse 11% 17% p=0.02

Conclusions

Most women under 45 years are diagnosed with breast cancer due to symptoms, since they are excluded from screening programs. No differences were found in family background between the two groups. Women who are screened are diagnosed with a statistically significantly lower stage, less lymph node involvement, receive less chemotherapy, less radiotherapy, and have fewer relapses. Screening programs in young patients could avoid some of the treatments and related late side effects.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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175P - Tumor biology in Young Breast Cancer Patients (YBCP). A different disease?

Abstract

Background

Breast cancer in Young patients has been related to a more aggressive tumor biology in some studies, due to a more frequent triple negative disease, grade III or vascular/lymphatic invasion. Early age at the time of breast cancer diagnosis has emerged worldwide as an independent factor associated with an increased risk of relapse and death regardless of the treatment administered with some controversies in the cut-off age (40 vs 45).

Methods

We have performed a retrospective analysis of YBCP (≤45 years) treated at the Oncology Department in HUPHM in Madrid-Spain, diagnosed with infiltrating breast cancer between 2009-2019. All data from the pathology and immunohistochemical report were collected and analyzed. We have examined the difference between subtypes and pathological characteristics according to age (<40 and ≥40-45).

Results

From a total of 600 YBCP analyzed, we identified 559 with infiltrating breast carcinoma of which we have a pathological report. The differences according to age are shown below:

<40 ≥40-45 Global population p value
Histology Ductal Lobulillar Other 89% 5% 6% 82% 11% 7% 84% 9% 7% p = 0,1
Grade I II III Unknown 18% 45% 32% 5% 21% 47% 28% 4% 20% 46% 30% 4% p = 0,6
Multicentricity 26% 33% 31% p = 0,09
Histologic Subtypes: Triple Negative HR+ HER2- HR+ HER2+ HR-HER2+ 12% 70% 13% 5% 12% 71% 12% 5% 12% 71% 12% 5% p = 0,9
Ki-67 < 14 ≥ 15 32% 68% 38% 62% 36% 64% p = 0,18
Hormone Receptor ER-/PR- ER+/PR- ER-/PR+ ER+/PR+ 17% 5% 2% 76% 16% 6% 2% 76% 16% 6% 2% 76% p = 0,9
Lymphovascular invasion 35% 35% 35% p = 0,9
Perineural invasion 14% 13% 13% p = 0,8

Conclusions

Most of the tumours were invasive ductal carcinoma, just 20% were grade I, only 12% triple negative tumors, 64% of the tumors had a high ki-67, 83% were hormone receptor positive (76% of them positive for both receptors). Lymphovascular and perineural invasion was present in 35% and 13% respectively. No significant differences were found according to age, with a similar distribution in the different subtypes and prognostic features.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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Presenter Of 1 Presentation

 On-Demand ePoster Display

174P - Breast screening at young age. A real need?

Abstract

Background

Screening mammography are stablished between the age of 50-69 years in most countries with a few exceptions in those patients with a higher risk (BRCA, Family background…). Breast cancer in patients under 45 is about 15% of all new diagnosis. The clinical impact of treatment is often significant in this particular vulnerable population.

Methods

A retrospective observational study of young breast cancer patients (YBCP ≤45 years old) diagnosed between 2009-2019 in HUPHM was carried out. The main objective was to explore difference between asymptomatic patients (screening) versus symptomatic patients (lump, swelling, pain…). Epidemiological, clinical, pathologic and treatment information was collected.

Results

We analyzed 590 young patients (≤ 45 years old) with a new diagnosis of in situ or infiltrating breast cancer. Results are summarized in the table below.

Asymptomatic Symptomatic univariate analysis, p
N (%) 162 (27%) 428 (73%)
Median age/range 41,9 (26-45) 41,2 (28-45)
Stage 0 (in situ) 20% 5% p=0.001
Stage I 46% 30% p=0.001
Stage II 25% 40% p=0.001
Stage III 6% 20% p=0.001
Stage IV 3% 5% p=0.01
Family background 40% 32% p=0.091
BRCA 1/2 8% 5% p=0.14
Lymph node positive 24% 45% p=0.0001
Mastectomy/Breast conservative 64%/36% 72%/28% p=0.1
Neoadyuvant CT 13% 30% p=0.0001
CT neo or adyuvant 54% 79% p=0.0001
Radiotherapy 31% 54% p=0.0001
Relapse 11% 17% p=0.02

Conclusions

Most women under 45 years are diagnosed with breast cancer due to symptoms, since they are excluded from screening programs. No differences were found in family background between the two groups. Women who are screened are diagnosed with a statistically significantly lower stage, less lymph node involvement, receive less chemotherapy, less radiotherapy, and have fewer relapses. Screening programs in young patients could avoid some of the treatments and related late side effects.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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