Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India
Jyoti Bajpai,
Pradeep Ventrapati,
Shalaka Joshi,
Tabassum Wadasadawala,
Sushmita Rath,
Rima Pathak,
Ravindra Nandhana,
Samarpita Mohanty,
Qurratulain Chougle,
Mitchelle Engineer,
Nissie Abraham,
Jaya Ghosh,
Nita Nair,
Seema Gulia,
Palak Popat,
Patil A,
Tanuja Sheth,
Sangeeta Desai,
Meenakshi Thakur,
Venkatesh Rangrajan,
Vani Parmar,
R. Sarin,
S. Gupta,
R.A. Badwe
Affiliations
Jyoti Bajpai
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India; Corresponding author. Medical Oncology, Room 1115, HBB, Tata Memorial Centre, Parel, Mumbai, 400012, India.
Pradeep Ventrapati
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Shalaka Joshi
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Tabassum Wadasadawala
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Sushmita Rath
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Rima Pathak
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Ravindra Nandhana
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Samarpita Mohanty
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Qurratulain Chougle
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Mitchelle Engineer
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Nissie Abraham
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Jaya Ghosh
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Nita Nair
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Seema Gulia
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Palak Popat
Department of Radiology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Patil A
Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Tanuja Sheth
Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Sangeeta Desai
Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Meenakshi Thakur
Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Venkatesh Rangrajan
Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Vani Parmar
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
R. Sarin
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
S. Gupta
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
R.A. Badwe
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
Background: Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. Methods: The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. Results: There were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. Conclusion: More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.
