Younger Breast Cancer Patients Face Higher Recurrence Risk: A Detailed Clinical Analysis
This article explores groundbreaking findings from a new retrospective cohort study that reveals younger women aged 21-35 with ER-positive, ERBB2-negative breast cancer face significantly higher risks of recurrence, including late distant metastasis, compared to older age groups. Discover the implications for clinical practice, tailored treatment strategies, and the urgent need for age-specific interventions to improve survival outcomes in this vulnerable demographic.

Abstract
Younger age is emerging as an independent risk factor for poorer oncologic outcomes in patients with estrogen receptor (ER)-positive, ERBB2-negative breast cancer. This study highlights that patients aged 21-35 years experience significantly worse survival outcomes, including locoregional recurrence-free survival, disease-free survival, and late distant-metastasis-free survival, compared to older groups. This disparity underscores the need for tailored treatment approaches to address this vulnerable population's unique challenges.
Introduction
Breast cancer remains one of the most prevalent cancers globally, with significant variation in survival outcomes based on tumor biology, stage, and patient demographics. Younger women diagnosed with breast cancer frequently exhibit aggressive disease characteristics, which may compromise long-term survival despite advancements in treatment modalities. This study, led by Dong Seung Shin, MD, of Samsung Medical Center, provides critical insights into how age impacts recurrence rates among younger women with ER-positive, ERBB2-negative breast cancer.
Methodology
A retrospective cohort analysis was conducted on 2,772 women aged 21-45 years diagnosed with ER-positive, ERBB2-negative breast cancer. The study focused on late distant recurrence—defined as recurrence occurring more than five years after initial surgery. Patients were stratified into three age groups based on age at diagnosis:
- 21-35 years (n = 370)
- 36-40 years (n = 885)
- 41-45 years (n = 1517)
All participants had no distant recurrence within the first five years post-surgery and underwent adjuvant endocrine therapy for at least two years. The median follow-up period was 10.8 years, providing robust data on long-term outcomes. Statistical analyses assessed the relationship between age and oncologic outcomes, including disease-free survival, locoregional recurrence-free survival, and late distant-metastasis-free survival.
Findings
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Survival Outcomes by Age Group
- Patients aged 21-35 years had significantly lower 10-year locoregional recurrence-free survival (90.1%) compared to 94.6% for ages 36-40 and 97.7% for ages 41-45.
- Disease-free survival rates followed a similar pattern: 79.3% for the youngest group versus 88.7% and 94.4% for the older groups.
- Late distant-metastasis-free survival rates at 10 years were 89.3% for the youngest group, significantly lower than 94.2% and 97.2% for patients aged 36-40 and 41-45, respectively.
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Risk of Late Distant Recurrence
- Younger patients (21-35 years) faced a 47% higher risk of late distant recurrence compared to those aged 36-40 years (adjusted hazard ratio [aHR], 0.53; P = .001).
- Patients aged 41-45 years had an even lower risk, with a 70% reduced likelihood of late distant recurrence (aHR, 0.30; P < .001).
- Each incremental year in age at diagnosis was associated with a 9% lower risk of late distant recurrence (aHR, 0.91; P < .001).
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Endocrine Therapy Adherence
- Adherence to endocrine therapy was a significant determinant of outcomes. A larger proportion of the youngest patients (15.9%) received less than five years of therapy compared to older groups (7.9% for ages 36-40 and 7.4% for ages 41-45).
Implications for Clinical Practice
The findings emphasize that younger patients with ER-positive, ERBB2-negative breast cancer are at a disproportionately higher risk of recurrence, particularly late distant metastasis. Age-specific treatment strategies are critical to improving outcomes, including:
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Extended Endocrine Therapy
- Extending therapy beyond five years may benefit younger patients, who are more likely to experience recurrence after this period.
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Ovarian Function Suppression
- Incorporating ovarian suppression for high-risk, younger patients may reduce recurrence rates and improve survival outcomes.
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Patient-Centered Support Programs
- Addressing adherence barriers, such as side effects and psychosocial challenges, is vital for ensuring young patients complete recommended therapy durations.
Discussion
Younger breast cancer patients often face unique biological and socioeconomic challenges. These may include more aggressive tumor subtypes, limited access to care, or difficulties balancing treatment with family and career responsibilities. This study provides compelling evidence that age, independent of other factors, significantly impacts oncologic outcomes.
Limitations
The study acknowledges several limitations:
- Geographic and Demographic Specificity: Data were collected in a single country, focusing on a homogenous population, limiting global applicability.
- Incomplete Data on Ovarian Suppression: Detailed information on ovarian function suppression was unavailable, which may have influenced recurrence rates.
- Variability in Therapy Duration: Differences in endocrine therapy duration among younger patients could have skewed results.
Despite these limitations, the findings underscore the importance of individualized care for younger breast cancer patients.
Conclusion
Younger women, particularly those under 35 years, face a significantly higher risk of late distant recurrence compared to older patients. As the study suggests, tailoring treatment regimens, improving adherence to endocrine therapy, and considering age-specific interventions can enhance survival outcomes.
Recommendations for Further Research
Future studies should explore:
- The role of genetic and lifestyle factors in recurrence risk among younger women.
- Longitudinal data from diverse populations to enhance the generalizability of findings.
- Optimal strategies for integrating ovarian function suppression into treatment protocols.
Funding and Disclosures
The study was supported by grants from the National Research & Development Program for Cancer Control and the Institution of Quality of Life in Cancer. The authors disclosed receiving funding from various institutions, highlighting the collaborative effort behind this research.
Sources
Shin, D. S., et al. (2024). Late Distant Recurrence Risk in Younger Breast Cancer Patients. JAMA Network Open.
National Cancer Institute. (2023). Breast Cancer Statistics.
American Cancer Society. (2023). Hormone Therapy for Breast Cancer: Guidelines and Recommendations.
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