Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease

Jennifer L Gnerlich; Anjali D Deshpande; Donna B Jeffe; Allison Sweet; Nick White; Julie A Margenthaler

doi:10.1016/j.jamcollsurg.2008.12.001

Back

Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease

Journal article

Peer reviewed

Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease

Jennifer L Gnerlich, Anjali D Deshpande, Donna B Jeffe, Allison Sweet, Nick White and Julie A Margenthaler

Journal of the American College of Surgeons, Vol.208(3), pp.341-347

03/2009

DOI: 10.1016/j.jamcollsurg.2008.12.001

PMCID: PMC3262236

PMID: 19317994

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/3262236View

Open Access

Abstract

We investigated differences in breast cancer mortality between younger (younger than 40 years of age) and older (40 years of age and older) women by stage at diagnosis to identify patient and tumor characteristics accounting for disparities. We conducted a retrospective study of women diagnosed with breast cancer in the 1988 to 2003 Surveillance, Epidemiology, and End Results Program data. Multivariate Cox regression models calculated adjusted hazard ratios (aHR) and 95% confidence intervals to compare overall and stage-specific breast cancer mortality in women younger than 40 years old and women 40 years and older, controlling for potential confounding variables identified in univariate tests. Of 243,012 breast cancer patients, 6.4% were younger than 40 years old, and 93.6% were 40 years of age or older. Compared with older women, younger women were more likely to be African American, single, diagnosed at later stages, and treated by mastectomy. Younger women had tumors that were more likely to be higher grade, larger size, estrogen receptor/progesterone receptor-negative, and lymph-node positive (p < 0.001). Younger women were more likely to die from breast cancer compared with older women (crude HR = 1.39; CI, 1.34 to 1.45). Controlling for confounders, younger women were more likely to die compared with older women if diagnosed with stage I (aHR = 1.44; CI, 1.27 to 1.64) or stage II (aHR = 1.09; CI, 1.03 to 1.15) disease and less likely to die if diagnosed with stage IV disease (aHR = 0.85; CI, 0.76 to 0.95). Higher breast cancer mortality in younger women was attributed to poorer outcomes with early-stage disease. Additional studies should focus on specific tumor biology contributing to the increased mortality of younger women with early-stage breast cancer.

Multivariate Analysis

Confidence Intervals

Age Distribution

Prognosis

Age Factors

Humans

Middle Aged

Survival Rate

Lymphatic Metastasis

Cause of Death

Breast Neoplasms - metabolism

Receptors, Progesterone - metabolism

Breast Neoplasms - therapy

Disease-Free Survival

Breast Neoplasms - pathology

Aged, 80 and over

Adult

Breast Neoplasms - mortality

Estrogen Receptor alpha - metabolism

Female

Aged

Retrospective Studies

Neoplasm Staging

Cohort Studies

Details

Title: Subtitle: Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease
Creators: Jennifer L Gnerlich - Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
Anjali D Deshpande
Donna B Jeffe
Allison Sweet
Nick White - Washington University in St. Louis
Julie A Margenthaler
Resource Type: Journal article
Publication Details: Journal of the American College of Surgeons, Vol.208(3), pp.341-347
DOI: 10.1016/j.jamcollsurg.2008.12.001
PMID: 19317994
PMCID: PMC3262236
NLM abbreviation: J Am Coll Surg
ISSN: 1072-7515
eISSN: 1879-1190
Publisher: United States
Grant note: P30 CA091842 / NCI NIH HHS T32 CA009621 / NCI NIH HHS P30 CA91842 / NCI NIH HHS P30 CA091842-04 / NCI NIH HHS
Language: English
Date published: 03/2009
Academic Unit: Epidemiology
Record Identifier: 9983996093202771

Metrics

20 Record Views

327 Times Cited - Web of Science