Factors influencing the effect of age on prognosis in breast cancer: population based study

doi:10.1136/bmj.320.7233.474

BMJ 2000;320:474-479 ( 19 February )

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Editorial by Dixon and Hortobagyi

Niels Kroman, senior registrar, ^a Maj-Britt Jensen, statistician, ^b Jan Wohlfahrt, senior statistician, ^a Henning T Mouridsen, consultant oncologist, ^b Per Kragh Andersen, professor, ^c Mads Melbye, professor. ^a

^a Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, DK 2300 Copenhagen, Denmark, ^b Danish Breast Cancer Cooperative Group, Rigshospitalet, DK 2100 Copenhagen, Denmark, ^c Department of Biostatistics, University of Copenhagen, DK 2200 Copenhagen, Denmark

Correspondence to: M Melbye mme{at}ssi.dk

Objective: To investigate whether young age at diagnosisis a negative prognostic factor in primary breast cancer and howstage of disease at diagnosis and treatment influences such anassociation.
Design: Retrospective cohort study based on a populationbased database of patients with breast cancer containing detailedinformation on tumour characteristics, treatment regimens, andsurvival.
Setting: Denmark.
Subjects: 10 356 women with primary breast cancer whowere less than 50 years old atdiagnosis.
Main outcome measures: Relative risk of dying within the first 10years after diagnosis according to age at diagnosis after adjustmentfor known prognostic factors and expectedmortality.
Results: Overall, young women with low risk diseasewho did not receive adjuvant treatment had a significantly increasedrisk of dying; risk increased with decreasing age at diagnosis(adjusted relative risk: 45-49 years (reference): 1; 40-44 years:1.12 (95% confidence interval 0.89 to 1.40); 35-39 years: 1.40(1.10 to 1.78); <35 years: 2.18 (1.64 to 2.89). However, no similartrend was seen in patients who received adjuvant cytotoxic treatment.The increased risk in younger women who did not receive adjuvanttreatment compared with those who did remained when women weregrouped according to presence of node negative disease and bytumoursize.
Conclusion: The negative prognostic effect of young ageis almost exclusively seen in women diagnosed with low risk diseasewho did not receive adjuvant cytotoxic treatment. These resultssuggest that young women with breast cancer, on the basis of agealone, should be regarded as high risk patients and be given adjuvantcytotoxictreatment.

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