Is tamoxifen alone adequate therapy in very young Chinese women with operable breast cancer?

Breast cancer occurs earlier in Chinese women than in Caucasian women. We have compared the clinicopathologic characteristics and prognosis in very young and older premenopausal women with breast cancer in south China. We separated 905 consecutive premenopausal patients with first diagnosis of breast cancer, surgically treated at the Sun Yat-sen University Cancer Center from October 2003 to December 2006, into a very young group (189 [13.7%]; <35 years old) and an older group (716 [52.0%]; 35-57 years old). Approximately, 90% of patients received adjuvant chemotherapy and hormonal therapy with tamoxifen for hormone-receptor (HR)-positive breast cancer. We retrospectively compared the clinicopathologic factors and survival rates of these two groups. The 3-year disease-free survival rate (78.0% versus 89.1%, p < 0.001) was poorer in the very young group, and 3-year overall survival rate (94.3% versus. 96.8%, p = 0.10) was similar. Moreover, the 3-year overall survival rate (p = 0.020) and disease-free survival rate (p < 0.001) were significantly poorer in HR-positive patients in the very young group whereas there was no significant difference in outcomes between the HR-negative groups. In China, age younger than 35 years is an independent predictor of breast cancer recurrence. In very young women with HR-positive breast cancer, chemotherapy plus tamoxifen alone may not be adequate standard treatment.