A report of 549 cases of breast cancer in women 35 years of age or younger.

Abstract

Young women who are not pregnant have an equal prognosis for the successful treatment of breast cancer as do older women. From analysis of data gathered in a study of 549 patients with histologically confirmed breast cancer made at Memorial Center for Cancer and Allied Diseases New York between 1937 and 1949 several suggestions are offered: 1) strict criteria of operability should be modified since even young women with axillary node metastases at the highest level have a 16% chance for a 5-year clinical cure; 2) when early diagnosis is made and prompt radical surgery performed when necessary the best chance for survival is offered; and 3) when tumors appear in the breast of pregnant women they should be diagnosed and treated immediately. More than 3/4 of the patients studied gave no indication of a family history of cancer. Of those who did report cancer in the family 35% of it involved the breast; 50% reported it in the mother and almost 25% in a sister. 82% were married and 66% had been pregnant at least once. 92% of the patients discovered the irregularity in the breast without medical assistance and only 1% of the tumors were discovered during routine physical examinations. In 5.5% nipple discharge was present serous discharge occurring 50% less frequently than bloody. Bloody discharge more frequently indicated an infiltrating duct carcinoma with no papillary component. 86.6% of the pathologic diagnoses were accounted for by infiltrating duct carcinoma. Clinical cure rate could be estimated as a minimum of 30.7% and a maximum of 40.6% over 5 years. This compared favorably with the statistics for older women. The clinical cure rate was lower than that found in older women when axillary node involvement was present. Cancers located in the outer half of the breast had an 8% better clinical cure rate compared with the rate for inner half midline and central lesions combined when axillary nodes were not involved. Prognosis was better for patients with less common types of breast cancer including medullary comedo and colloid carcinoma than for infiltrating duct carcinoma. Axillary node metastasis also occurred less frequently. No conclusions regarding the management of concurrent or subsequent pregnancies were formed. Although concurrent pregnancy creates a poor prognosis pregnancies subsequent to surgical therapy seemed to have little influence. Postoperative X-ray therapy had no influence on the clinical cure rates. Median duration of life for those considered clinical failures was slightly over 2 years. In 399 patients treated by radical mastectomy there was no postoperative mortality. Prophylactic castration was of 8.3% value when the axillary nodes were involved. Prophylactic simple mastectomy is not recommended even in the presence of a significant familial history of breast cancer. The size of the tumor was of great prognostic importance whether the axillary nodes were involved or free of metatases.