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IN2 Debate: The biology of breast cancer in young women is unique – In favour
The Breast 21S1 (2012) S1–S9
Contents lists available at SciVerse ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Invited Speakers’ Abstracts IN1 YSC – Young Survival Coalition A. Cluxton *. Young Survival Coalition, Ex Officio, YSC Board of Directors, Columbus, OH, USA Young Survival Coalition (YSC) is the premier global organization dedicated to the critical issues unique to young women and breast cancer. YSC offers resources, connections, and outreach so women feel supported, empowered and hopeful. YSC advocates for increasing the quality and quantity of research in many areas including (but not limited to): • Identification of factors that increase the risk of breast cancer in young women • Pregnancy and breast cancer • Treatment of breast cancer in young women • Fertility concerns • Metastasis • Quality of life and survivorship YSC has been helping to affect change in the support and treatment of young women with breast cancer for nearly 15 years. In that time, much has changed. Unfortunately, much has also stayed the same. Through this presentation, attendees will develop a better understanding of the issues affecting young women with breast cancer from the perspective of a support organization, as well as from that of a survivor.
Session I. Debate: The biology of breast cancer in young women is unique IN2 Debate: The biology of breast cancer in young women is unique – In favour M. Colleoni *. European Institute of Oncology, Medical Oncology Division, Milan, Italy Breast cancer at a young age, though the age definition for young is very variable, has been reported to pursue a more aggressive clinical course and to be associated with a more unfavorable prognosis compared with the disease in older patients. Recent studies reported that pathological tumor size, nodal status and number of positive axillary lymph-nodes have a similar distribution among the younger and the older cohorts, thus not supporting previous data indicating more advanced disease in younger patients at diagnosis of operable disease. However, compared with less young premenopausal patients, very young women (below 35 years) have a greater chance of having an endocrine-unresponsive tumor, and are more likely to present with a higher grade, more extensively proliferating and vessel invading disease. Similar results were observed also in selected population considered to be at lower risk (node-negative disease). Moreover, a higher prevalence of aggressive molecular subtypes such as basal-like tumors, in young women with breast cancer was reported. According to immunohistochemically 0960-9776/ $ – see front matter © 2012 Elsevier Ltd. All rights reserved.
(IHC) defined subtypes there were less tumors identified as Luminal A and more Triple Negative tumors in the group of patients aged <35 years, than in older patients. These results might support the hypothesis that that age alone has not a biological influence beyond that of breast cancer subtype and biological features. However, poor outcome of young breast cancer patients was reported also after adjusting for disease features such as ER, grade, and HER2 status. Very young patients with tumors IHC classified as Luminal B, HER2 and Triple Negative subtype were at increased risk of events when compared with older patients with the same subtype. Moreover, expression of genes and gene sets were found to be significantly age dependent. Distinct molecular processes including those related to immature mammary epithelial cells and growth factor signalling are present in breast cancer arising at a young age. These data indicate that breast cancer, which develops at a young age, is different biologically from that arising in older premenopausal patients. IN3 Debate: The biology of breast cancer in young women is unique – Against C.K. Anders *. UNC Linenberger Comprehensive Cancer Center, Chapel Hill, NC, USA There is no question that breast cancer arising in young women is unique in many aspects. Challenges faced by young women diagnosed with breast cancer are often quite different than those experienced by older women. These unique challenges may include disruption of career in its early phase, child-bearing and ongoing family responsibilities, impact of therapy on sexuality and body image, and the psychosocial toll of facing a life-threatening illness at a young age. Historically, multiple studies have shown that younger women tend to experience worse breast cancer outcomes as compared to older counterparts, however the reason for this observation is not entirely known. Studies have also shown that the more aggressive subtypes of breast cancer (i.e. basal-like and HER2-enriched) are over-represented among younger women aged ≤45 years as compared to older women aged ≥65 years. Taking a more detailed view of the biology of young women’s breast tumors using gene expression data from several large, publically-available data sets in a non-subtype-dependent manner, breast tumors arising in younger women were enriched for ≥350 biologically-relevant gene sets and hundreds of individual genes compared to older women. However, when adjusting for significant clinicopathologic features including grade and subtype, adjusted models yielded negligible gene differences between breast tumors arising from defined age groups of ≤45versus ≥65 years – a finding that was validated in an independent dataset. This data argues that the biology of young women’s breast tumors may not be unique, but rather that the overrepresentation of aggressive subtypes is accounting for disparities in outcome by age. While this information is compelling, many unanswered questions remain including (1) why are younger women more prone to aggressive subtypes of breast cancer, (2) what is the
Contents lists available at SciVerse ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Invited Speakers’ Abstracts IN1 YSC – Young Survival Coalition A. Cluxton *. Young Survival Coalition, Ex Officio, YSC Board of Directors, Columbus, OH, USA Young Survival Coalition (YSC) is the premier global organization dedicated to the critical issues unique to young women and breast cancer. YSC offers resources, connections, and outreach so women feel supported, empowered and hopeful. YSC advocates for increasing the quality and quantity of research in many areas including (but not limited to): • Identification of factors that increase the risk of breast cancer in young women • Pregnancy and breast cancer • Treatment of breast cancer in young women • Fertility concerns • Metastasis • Quality of life and survivorship YSC has been helping to affect change in the support and treatment of young women with breast cancer for nearly 15 years. In that time, much has changed. Unfortunately, much has also stayed the same. Through this presentation, attendees will develop a better understanding of the issues affecting young women with breast cancer from the perspective of a support organization, as well as from that of a survivor.
Session I. Debate: The biology of breast cancer in young women is unique IN2 Debate: The biology of breast cancer in young women is unique – In favour M. Colleoni *. European Institute of Oncology, Medical Oncology Division, Milan, Italy Breast cancer at a young age, though the age definition for young is very variable, has been reported to pursue a more aggressive clinical course and to be associated with a more unfavorable prognosis compared with the disease in older patients. Recent studies reported that pathological tumor size, nodal status and number of positive axillary lymph-nodes have a similar distribution among the younger and the older cohorts, thus not supporting previous data indicating more advanced disease in younger patients at diagnosis of operable disease. However, compared with less young premenopausal patients, very young women (below 35 years) have a greater chance of having an endocrine-unresponsive tumor, and are more likely to present with a higher grade, more extensively proliferating and vessel invading disease. Similar results were observed also in selected population considered to be at lower risk (node-negative disease). Moreover, a higher prevalence of aggressive molecular subtypes such as basal-like tumors, in young women with breast cancer was reported. According to immunohistochemically 0960-9776/ $ – see front matter © 2012 Elsevier Ltd. All rights reserved.
(IHC) defined subtypes there were less tumors identified as Luminal A and more Triple Negative tumors in the group of patients aged <35 years, than in older patients. These results might support the hypothesis that that age alone has not a biological influence beyond that of breast cancer subtype and biological features. However, poor outcome of young breast cancer patients was reported also after adjusting for disease features such as ER, grade, and HER2 status. Very young patients with tumors IHC classified as Luminal B, HER2 and Triple Negative subtype were at increased risk of events when compared with older patients with the same subtype. Moreover, expression of genes and gene sets were found to be significantly age dependent. Distinct molecular processes including those related to immature mammary epithelial cells and growth factor signalling are present in breast cancer arising at a young age. These data indicate that breast cancer, which develops at a young age, is different biologically from that arising in older premenopausal patients. IN3 Debate: The biology of breast cancer in young women is unique – Against C.K. Anders *. UNC Linenberger Comprehensive Cancer Center, Chapel Hill, NC, USA There is no question that breast cancer arising in young women is unique in many aspects. Challenges faced by young women diagnosed with breast cancer are often quite different than those experienced by older women. These unique challenges may include disruption of career in its early phase, child-bearing and ongoing family responsibilities, impact of therapy on sexuality and body image, and the psychosocial toll of facing a life-threatening illness at a young age. Historically, multiple studies have shown that younger women tend to experience worse breast cancer outcomes as compared to older counterparts, however the reason for this observation is not entirely known. Studies have also shown that the more aggressive subtypes of breast cancer (i.e. basal-like and HER2-enriched) are over-represented among younger women aged ≤45 years as compared to older women aged ≥65 years. Taking a more detailed view of the biology of young women’s breast tumors using gene expression data from several large, publically-available data sets in a non-subtype-dependent manner, breast tumors arising in younger women were enriched for ≥350 biologically-relevant gene sets and hundreds of individual genes compared to older women. However, when adjusting for significant clinicopathologic features including grade and subtype, adjusted models yielded negligible gene differences between breast tumors arising from defined age groups of ≤45versus ≥65 years – a finding that was validated in an independent dataset. This data argues that the biology of young women’s breast tumors may not be unique, but rather that the overrepresentation of aggressive subtypes is accounting for disparities in outcome by age. While this information is compelling, many unanswered questions remain including (1) why are younger women more prone to aggressive subtypes of breast cancer, (2) what is the