B14
Young onset breast cancer patients who develop distant metastases within 12 months of primary diagnosis
Sue Gerty, Will Tapper, Peter Simmonds, Diana Eccles
University of Southampton, UK, and Southampton University Hospitals NHS Trust, UK
Aim
To characterise the clinical features in young breast cancer patients who develop distant metastases within one year of breast cancer diagnosis.
Method
We reviewed the presenting characteristics of 2845 women aged ≤40 years diagnosed with invasive breast cancer between January 2000 and December 2007 and participating in the POSH* study. 137 (4%) of these patients either presented with metastases or developed distant metastases within 12 months of diagnosis.
Results
Of the 137 women with early metastatic disease, 70 presented with M1 disease and 67 presented with M0 but developed distant metastases within the first 12 months. The most frequent site of first metastasis was bone (48%), then liver (26%), supra-clavicular lymph nodes (11%), lung (8%), brain (5%) and other (2%). The average age at diagnosis for cases with early relapse was less than for the whole cohort (34.7 versus 36). Compared with the whole cohort, the primary breast cancers of cases with early relapse were more often ER negative (42% v 33%), HER2+ (34% v 31%), PR negative (51% v 43%), multifocal (38% v 30%), and slightly fewer women reported a family history of breast cancer (44% v 47%). There were also significantly more self identified Black women with early relapses than expected (X2=9.40, p<0.009). We compared the characteristics of the 70 M1 cases with the 67 M0 women with early metastases. Those presenting with M1 disease were much more likely to have ER positive disease (X2= 14.41, p<0.0001) however HER2 positive tumours were not significantly different between the two groups (X2=0.26, p<0.61) or the whole cohort. Bone was a more common site of initial metastatic disease for M1 compared to M0 patients (X2=3.2, p<0.07).
Conclusion
Early relapse amongst young patients with breast cancer is associated with many of the adverse prognostic factors already known however primary breast cancers that present with distant metastases have a very significantly different hormone receptor profile compared with cases presenting with early disease relapse. This represents a preliminary observation in a large cohort study is intriguing and needs further exploration.
*(POSH) is a Prospective study of Outcomes in Sporadic versus Hereditary breast cancer [Eccles et al 2007]
Acknowledgements
The POSH study steering group
CRUK funding and the NCRN
