Disease Severity, Presentation, and Clinical Outcomes Among Adolescents With Malignant Breast Neoplasms: A 20-Year Population-Based Outcomes Study From the SEER Database (1973-2009).

Introduction Primary breast cancer in adolescents is extremely rare, hence not widely studied. This study aimed to evaluate trends, characteristics and outcomes among a cohort of adolescents with breast cancer. Methods 657,712 female patients with breast cancer from Surveillance Epidemiology and End Results (SEER) database (1973-2009) were analyzed and 91 adolescents were identified. Three age groups (under 20 years, 20-50 years or premenopausal and >50 years or postmenopausal) were compared for tumor size, stage, receptor status and outcomes. Categorical data was compared using Chi square (Fischer) test and continuous data with Students t test. Results Median age was 19 years (range 10-20 years). 52.7% (N= 48) and 5.5% (N= 5) of patients presented with invasive and in situ cancers respectively and 37.3% (N= 34) with sarcomas. Median tumor size of invasive cancers was 3.2 cm (range 0.1-12.5 cm). 60% of patients presented with regional disease and majority (28%) of those tested were receptor negative. Mortality rates in adolescents were higher than pre and postmenopausal patients in localized and regional stage. Overall median survival was 106 months. Conclusions Although rare, breast cancer does occur in adolescent females and must be considered in differential of breast masses in females under 20, especially with strong breast cancer family history. Prognosis maybe worse than in older patients; however sample size is small. Delay in diagnosis, aggressive tumor biology and negative receptor status may affect prognosis. Routine breast examination in high risk older adolescents may permit early identification and avoid delay in diagnosis and treatment.