Clinicopathologic Features and Molecular Subtypes of Breast Cancer in Young Women (Age ≤35)

  • Goksu, Sema Sezgin (Department of Medical Oncology, Kayseri State Hospital of Research and Education) ;
  • Tastekin, Didem (Department of Medical Oncology, Istanbul University, Istanbul Faculty of Medicine) ;
  • Arslan, Deniz (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Gunduz, Seyda (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Tatli, Ali Murat (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Unal, Dilek (Department of Radiation Oncology, Kayseri State Hospital of Research and Education) ;
  • Salim, Derya (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Guler, Tunc (Department of Medical Oncology, Selcuk University, Meram Faculty of Medicine) ;
  • Coskun, Hasan Senol (Department of Medical Oncology, Akdeniz University, Faculty of Medicine)
  • Published : 2014.08.30


Introduction: Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. Materials and Methods: Patients with breast cancer aged 35 or less (${\leq}35$ years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. Results: The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. Conclusions: Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma.


Young patients;breast cancer;molecular characteristics;clinicopathological features;Turkey


  1. Anders CK, Johnson R, Litton J, Phillips M, Bleyer A (2009). Breast cancer before age 40 years. Semin Oncol, 36, 237-49.
  2. Bleyer A, Barr R, Hayes-Lattin B, et al (2008); Biology and Clinical Trials Subgroups of the US National Cancer Institute Progress Review Group in Adolescent and Young Adult Oncology. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer, 8, 288-98.
  3. Cardoso F, Loibl S, Pagani O, et al (2012); European Society of Breast Cancer Specialists. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer, 48, 3355-77.
  4. Carey LA, Perou CM, Livasy CA, et al (2006). Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA, 295, 2492-502.
  5. Collins LC, Marotti JD, Gelber S, et al (2012). Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat, 131, 1061-6.
  6. Copson E, Maishman T, Gerty S, et al (2014). POSH study steering group, Eccles D. Ethnicity and outcome of young breast cancer patients in the United Kingdom: the POSH study. Br J Cancer, 110, 230-41.
  7. DeSantis C, Siegel R, Bandi P, Jemal A (2011). Breast cancer statistics, 2011. CA Cancer J Clin, 61, 409-18.
  8. Di Nubila B, Cassano E, Urban LA, et al (2006). Radiological features and pathological-biological correlations in 348 women with breast cancer under 35 years old. Breast, 15, 744-53.
  9. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  10. Fredholm H, Eaker S, Frisell J, et al (2009). Breast cancer in young women: poor survival despite intensive treatment. PLoS One, 11, 7695.
  11. Friedman LC, Kalidas M, Elledge R, et al (2006). Medical and psychosocial predictors of delay in seeking medical consultation for breast symptoms in women in a public sector setting. J Behav Med, 29, 327-34.
  12. Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST (2000). Stage 0 to stage III breast cancer in young women. J Am Coll Surg, 190, 523-9.
  13. Gnerlich JL, Deshpande AD, Jeffe DB, et al (2009). Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg, 208, 341-7.
  14. Johnson RH, Chien FL, Bleyer A (2013). Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA, 309, 800-5.
  15. Keegan TH, DeRouen MC, Press DJ, Kurian AW, Clarke CA (2012). Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res, 14, 55
  16. Keramatinia A, Mousavi-Jarrahi SH, Hiteh M, Mosavi-Jarrahi A (2014). Trends in incidence of breast cancer among women under 40 in Asia. Asian Pac J Cancer Prev, 15, 1387-90.
  17. Khurshid A, Faridi N, Arif AM, Naqvi H, Tahir M (2013). Breast lesions in adolescents and young women in Pakistan-a 5 year study of significance of early recognition. Asian Pac J Cancer Prev, 14, 3465-7.
  18. Kroman N, Jensen MB, Wohlfahrt J, et al (2000). Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ, 320, 474-8.
  19. Lin CH, Liau JY, Lu YS, et al (2009). Molecular subtypes of breast cancer emerging in young women in Taiwan: evidence for more than just westernization as a reason for the disease in Asia. Cancer Epidemiol Biomarkers Prev, 18, 1807-14.
  20. Litiere S, Werutsky G, Fentiman IS, et al (2012). Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 13, 412-9.
  21. Metcalfe K, Lynch HT, Ghadirian P, et al (2004). Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol, 22, 2328-35.
  22. Miles RC, Gullerud RE, Lohse CM, et al (2012). Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol, 19, 1153-9.
  23. Nixon AJ, Neuberg D, Hayes DF, et al (1994). Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol, 12, 888-94.
  24. Partridge AH, Hughes ME, Ottesen RA, et al (2012). The effect of age on delay in diagnosis and stage of breast cancer. Oncologist, 17, 775-82.
  25. Ruddy KJ, Gelber S, Tamimi RM, et al (2014). Breast cancer presentation and diagnostic delays in young women. Cancer, 120, 20-5.
  26. Tang J, Wu CC, Xie ZM, Luo RZ, Yang MT (2011). Comparison of Clinical Features and Treatment Outcome of Breast Cancers in Young and Elderly Chinese Patients. Breast Care (Basel), 6, 435-440.
  27. Thapa B, Singh Y, Sayami P, et al (2013). Breast cancer in young women from a low risk population in Nepal. Asian Pac J Cancer Prev, 14, 5095-9.
  28. Uyeturk U, Tatli AM, Gucuk S, et al (2013). Risk factors for stage IV breast cancer at the time of presentation in Turkey. Asian Pac J Cancer Prev, 14, 7445-9.
  29. Wei XQ, Li X, Xin XJ, Tong ZS, Zhang S (2013). Clinical features and survival analysis of very young (age<35) breast cancer patients. Asian Pac J Cancer Prev, 14, 5949-52.

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