© 2001 by Oxford University Press
Journal of the National Cancer Institute Monographs, No. 30, 44-51,
2001
© 2001 Oxford University Press
Adjuvant Therapy for Very Young Women With Breast Cancer: Need for Tailored Treatments
Affiliations of authors: A. Goldhirsch, International Breast Cancer Study Group (IBCSG), Bern, Switzerland, European Institute of Oncology, Milan, Italy, and Oncology Institute of Southern Switzerland, Lugano, Switzerland; R. D. Gelber, IBCSG Statistical Center, and Dana-Farber Cancer Institute, Boston, MA; G. Yothers, National Surgical Adjuvant Breast and Bowel Project (NSABP) Biostatistical Center and Department of Statistics, University of Pittsburgh, Pittsburgh, PA; R. J. Gray, Eastern Cooperative Oncology Group Statistical Center, Boston, MA, and Dana-Farber Cancer Institute, Boston, MA; S. Green, Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; J. Bryant, NSABP Biostatistical Center and Departments of Statistics and Biostatistics, University of Pittsburgh, PA; S. Gelber, IBCSG Statistical Center, Boston, and Frontier Science and Technology Research Foundation, Brookline, MA; M. Castiglione-Gertsch, IBCSG Coordinating Center and University of Bern, Switzerland; A. S. Coates, University of Sydney and Australian Cancer Society, Sydney, Australia
Correspondence to: Aron Goldhirsch, M.D., International Breast Cancer Study Group, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy (e-mail: agoldhirsch{at}sakk.ch).
Breast cancer rarely occurs in women below the age of 35 years. Data from various sources indicate that diagnosis at such an age is associated with a dire prognosis mainly because of a more aggressive presentation. Although the effect of chemotherapy for premenopausal patients is substantial, recent evidence on 2233 patients suggested that very young women with endocrine-responsive tumors had a statistically significantly higher risk of relapse than older premenopausal patients with such tumors. In contrast, results for younger and older premenopausal patients were similar if their tumors were classified as endocrine nonresponsive. Information from studies on 7631 patients who were treated with chemotherapy alone in trials of three major U.S. cooperative groups showed a similar interaction between the effect of age and steroid hormone receptor status of the primary tumor. Better treatments for very young patients are required and may involve ovarian function suppression in addition to other endocrine agents in patients with endocrine responsive tumors and a more precise investigation of chemotherapy and its timing, duration, and intensity in those with endocrine nonresponsive tumors. Very young women with this disease are faced with personal, family, professional, and quality-of-life issues, which further complicate the phase of treatment decision making. The development of more effective therapies for younger patients requires tailored treatment investigations and cannot rely on information predominantly contributed from older premenopausal women.
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