Descriptive analysis of 192 cases of breast cancer occurring before age 40 in Yaounde, Cameroon
Keywords:Breast cancer, Diagnosis, Outcome, Survival, Young women
Background: Breast cancer is today a global health problem. With 1,671,149 new cases diagnosed in 2012, it is the most common female cancer in the world and accounts for 11.9% of all cancers and it affects more people than prostate cancer. In 2008, The United States statistics showed that, for all cancer that affect women before 40 years, more than 40% of them concerned the breast. The aim of this study was to describe the clinical, histopathological and therapeutic aspects of breast cancer in women under 40 years of age in Yaoundé.
Methods: This was a retrospective study with data collected from 192 medical case files of women treated over a period of 12 years, from January 2004 to December 2015 at the Yaounde General Hospital and the Yaounde Gyneco-Obstetric and Pediatric Hospital. Microsoft Epi Info version 3.4.5 and SPSS version 20.0 softwares were used for data analysis.
Results: From 2004 to 2015, 1489 cases of breast cancer were treated in both hospitals. Of these, 462 women were less than 40 years old, representing a proportion of 31.0%. The mean age at diagnosis was 33.5±5.0 years and 17.7% of women had a family history of breast cancer. The average time before an initial consultation was 6.7±6.6 months. Most cases were classified as T4 (46.1%). The most common histological type was ductal carcinoma (87.4%). Grades SBR II and SBR III were predominant (76.4%). Axillary dissection (64.4%) and neoadjuvant chemotherapy (43.9%) were the main therapeutic modalities. The overall survival rate at 5 years was 51.2%. Five-year survival rates with no local recurrence and no metastatic occurrence were 35.8% and 43.2% respectively.
Conclusions: Breast cancer largely affects women under the age of 40 and is often discovered late, at an advanced stage. The prognosis appears poor. Only screening could facilitate diagnosis at an early stage of the disease for better outcomes.
International Agency for Research on Cancer Globocan 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012/populations fact sheets. 2012. Available at http://globocan.iarc.fr/pages/fact_sheets_population.aspx.
Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast Cancer Before Age 40 Years. Semin Oncol. 2009;36(3):237-49. WB Saunders
Kheirelseid EAH, Boggs JME, Curran C, Glynn RW, Dooley C, Sweeney KJ, et al. Younger age as a prognostic indicator in breast cancer: A cohort study. BMC Cancer. 2011;11:383.
Thangjam S, Laishram RS, Debnath K. Breast carcinoma in young females below the age of 40 years: A histopathological perspective. South Asian J Cancer. 2014;3:97-100.
Slaoui M, Mouh FZ, Ghanname I, Razine R, El Mzibri M, Amrani M. Outcome of breast cancer in moroccan young women correlated to clinic-pathological features, risk factors and treatment: a comparative study of 716 cases in a single institution. PLoS ONE 11 (10): e0164841.
Yeo W, Lee HM, Chan A, Chan EY, Chan MC, Chan KW et al. Risk factors and natural history of breast cancer in younger Chinese women. World J Clin Oncol. 2014;5(5):1097-106.
Enow Orock GE, Ndom P, Doh AS. Current cancer incidence and trends in Yaounde, Cameroon. Oncol. Gastroenterol Hepatol Rep. 2012;1(1):58-63.
Kemfang NJD, Yomi J, Kasia JM, Mawamba Y, Ekortarh AC, Vlastos G. Breast cancer profile in a group of patients followed up at the radiation therapy unit of the Yaounde General Hospital, Cameroon. Obstet Gynecol Int. 2011;2011:143506.
Chollet-Hinton L, Anders CK, Tse CK, Bell MB, Yang YC, Carey LA, et al. Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer study: a case-control study. Breast Cancer Res. 2016;18(1):79.
Lee MK, Varzi LA, Chung DU, Cao M, Gornbein J, Apple SK, et al. The effect of young age in hormone receptor positive breast cancer. Biomed Res Int. 2015;2015:325715.
Bano R, Salim M, Abid M, Akif Zaidi, Khan AI. Prognosis of breast cancer in very young age (less than 30 years). J Cancer Allied Spec. 2016;2(1):4.
Mazeh H, Sagiv I, Katz D, Freund HR, Peretz T, Allweis TM. Association between patient age, volume of breast tissue excised, and local recurrence. The J Surg Res. 2013,181(2):187-192.
Essiben F, Foumane P, Mboudou E, Dohbit J, Mve Koh V, Ndom P. Diagnosis and Treatment of Breast Cancer in Cameroon: A Series of 65 Cases. Mali Medical. 2013;28:1-5.
Butt S, Borgquist S, Garne JP, Landberg G, Tengrup I, Olsson A et al. Parity in relation to survival following breast cancer. Eur J Surg Oncol. 2009;35(7):702-8.
Merviel P, Jouvance O, Naepels P, Fauvet R, Cabry-goubet R, Gagneur O, et al. Are there still risk factors for the onset of breast cancer? Gynecol Obstet Fertil. 2010;39́(2011):486-90.
Parsa P, Parsa B. Effects of reproductive factors on risk of breast cancer. Asian Pac J Cancer Prev. 2009;10:545-50.
Essiben F, Foumane P, Meka ENU, Soh PS, Dohbit JD, Osogo E, et al. Risk factors for breast cancer: a case-control study of 315 women followed in the Gynecology and Oncology Departments of Two University Teaching Hospitals in Yaounde, Cameroon. Open J Obstet Gynecol. 2016;6:676-88. Available at http://dx.doi.org/10.4236/ojog.2016.612085.
Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007;356(16):1670-4.
Bakkali H, Marchal C, Lesur- Schwander A, Verhaeghe JL. Breast cancer in women aged 30 and under. Cancer Radiother. 2003;7:153-9.
Boufettal H, Noun M, Samouh N. Breast cancer in young women in Morocco. Cancer Radiother. 2010 ;14:698-703.
Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The relationship of mammographic density and age: implications for breast cancer screening. AJR Am J Roentgenol. 2012;198(3):292-5.
Xiong Q, Valero V, Kau V, Kau SW, Taylor S, Smith TL, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M.D. Anderson Cancer Center experience. Cancer. 2001;92(10):2523-8.
Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, Montazeri A, et al. Twenty years of breast cancer in Iran: downstaging without a formal screening program. Ann Oncol. 2011;22(1):93-7.
Burgess CC, Ramirez AJ, Richards MA, Love SB. Who and what influences delayed presentation in breast cancer? Br J Cancer. 1998;77(8):1343-8.
Fancher TT, Palesty JA, Paszkowiak JJ, Kiran RP, Malkan AD, Dudrick SJ. Can breast self-examination continue to be touted justifiably as an optional practice? Int J Surg Oncol. 2011;965464.
Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134: 459-78.
Johnson RH, Hu P, Fan C, Anders CK. Gene expression in young adult type breast cancer: a retrospective analysis. Oncotarget. 2015;6:13688-702. PMID: 25999348.
Reyna C, Lee MC. Breast cancer in young women: special considerations in multidisciplinary care. J. Multidiscip Healthc. 2014;7:419-29.
Morrow M, White J, Moughan J, Owen J, Pajack T, Sylyester J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol. 2001;19:2254-62. PMID: 11304779.
Menard S, Casalini P, Cascinelli N, Balsari A. Breast carcinoma in young patients. Lancet. 2000;356:1113.