Breast Cancer in Young Women from a Low Risk Population in Nepal

Abstract

<b>Background:</b> The overall incidence of breast cancer in South Asian countries, including Nepal, is low comparedto Western countries. However, the incidence of breast cancer among young women is relatively high. Breastcancer in such cases is characterized by a relatively unfavorable prognosis and unusual pathological features.The aim of this study was to investigate clinico-pathological and biological characteristics in younger breastcancer patients (<40 years) and compare these with their older counterparts. Materials and <br/><b>Methods</b>: Ninehundred and forty four consecutive female breast cancer patients, admitted to the Department of Surgery,Tribhuvan University Teaching Hospital, Kathmandu, Nepal between November 1997 and October 2012, wereretrospectively analyzed. <br/><b>Results</b>: Out of the 944 female breast cancer patients, 263 (27.9%) were <40 years. Themean age was 34.6±5.0 years among younger patients compared to 54.1±9.9 for those ≥40 years. The mean age atmenarche was also significantly lower (13.5±1.5 vs 14.2±1.5 years p=0.001) while the mean duration of symptomswas significantly longer (7.6 vs 6.5 months p=0.004). Family history of breast cancer was evident in 3.0% of theyoung women versus 0.3% in the older one. Mammography was performed less frequently in younger patients(59.7%), compared to older (74.4%), and was of diagnostic benefit in only 20% of younger patients compared to85% of older ones. At diagnosis, the mean tumor diameter was significantly larger in young women (5.0±2.5 vs4.5±2.4cm, p=0.005). Axillary lymph nodes were positive in 73% of younger patients and 59% of older patients.In the younger group, the proportion of stage III or IV disease was higher (55.1% vs 47.1%, p≤0.05). Theproportion of breast conserving surgery was higher in young patients (25.1% vs 8.7%) and a higher proportionof younger patients receive neoadjuvant chemotherapy (9.9% vs 2.8%). The most common histological type wasductal carcinoma (93.1% vs 86%). The proportion of histological grade II or III was higher in younger patients(55.9% vs 24.5%). Similarly, in the younger group, lymphatic and vascular invasion was more common (63.2%vs 34.3% and 39.8% vs 25.4%, respectively). Patients in the younger age group exhibited lower estrogen and/or progesterone receptor positivity (34.7% vs 49.8%). Although statistically not significant, the proportion oftriple negative tumors in younger age group was higher (22.4% vs 13.6%). <br/><b>Conclusions</b>: Breast cancer in youngNepalese women represents over one quarter of all female breast cancers, many being diagnosed at an advancedstage. Tumors in young women exhibit more aggressive biological features. Hence, breast cancer in young womenis worth special attention for earlier detection.