Retrospective analysis of breast cancer among young African American females

Purpose. To evaluate the patterns of failure, relapse-free survival and overall survival among African American breast cancer patients younger than 40 years. Patients and methods. We retrospectively reviewed the records of 124 African American breast cancer patients younger than 40 years who were registered with the Howard University Cancer Center Database between 1990 and 1999. One hundred and six patients were found eligible and subsequently included in this analysis. Ninety-eight percent of these patients were pre-menopausal and 30% had a documented family history of breast cancer. Patient distribution per stage is as follows: 19%, stage I; 61%, stage II; 16%, stage III and 4%, stage IV. Surgery was a component of treatment for 98% of the patients. Forty-six percent underwent mastectomy, 47% had breast-conserving surgery and 5% underwent biopsy only. Fifty-nine percent of the patients received adjuvant radiation and 56% were also treated with adjuvant chemotherapy. Median follow-up was 35 months (range of 4-126 months). Results. Locoregional only first failure rate was 6% while systemic failure occurred in 20% of these patients. Among 17 stage III patients, 50% developed distant metastasis. The 5-year overall survival for these patients was 73%, with relapse-free survival being numerically similar. Patients with early stage disease, stages I and II, were noted to have 5-year overall survival rates of 100 and 78-83%, respectively. Those who presented with stage III or stage IV disease had dismal 5-year overall survival rates of 25-29 and 0%, respectively. Multivariate analysis using the Cox proportional hazard model identified the presence of metastasis as a factor that significantly affects survival in these young African American females. Conclusion. These results show that African American females younger than 40 years with early stage breast cancer have local control and survival rates comparable to that of the general population. In contrast, young African American females in this study, with stages III and IV disease, appear to suffer a worse prognosis despite standard therapy. A larger series of young African American females with breast cancer, followed for a longer period of time, will be required to confirm a negative trend in survival.