Johns Hopkins Medical Institutions, 600 North Wolfe St Radiology room 118, Baltimore, MD, 21287, USA.
DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, 1320 S Dixie Hwy, Coral Gables, FL, 33146, USA.
Breast Cancer Res Treat. 2021 Feb;186(1):209-217. doi: 10.1007/s10549-020-06000-x. Epub 2020 Nov 2.
Although uncommon, breast cancer is the leading cause of cancer death in young women. There are limited studies on the presentation and characteristics of breast cancer in women under age 40.
This is a retrospective study investigating patient demographics, clinical presentations, imaging findings, and cancer characteristics of a cohort of 145 women under age 40 with breast cancer.
Our cohort had more aggressive cancer subtypes than reported in older women; 33.1% triple negative, 80% high Ki-67, and 21.3% with stage 3+ disease. Most were referred from primary care or obstetrician/gynecologist, though 5.5% initially presented from the emergency department and another 2.1% were incidental findings. 16.6% of patients presented while pregnant or breastfeeding. Most patients presented with breast related symptoms. Of the 9.1% of patients diagnosed through our high-risk screening program, 84.6% of the cancers were identified on mammography or simultaneously with mammography and MRI. Most breast cancers presented with typically worrisome imaging (82.6%), though several cancers presented with findings that were typically benign.
We recommend prompt breast imaging for young women presenting with breast-related symptoms or an incidental breast finding, as younger patients have more aggressive cancer subtypes and are of a higher grade at presentation compared to older women. We also recommend vigilance when distinguishing suspicious symptoms from pregnancy-related breast changes to minimize delays in diagnosis. Additionally, it is important to identify patients who qualify for high risk screening, since cancers in screening patients were found at a lower grade than those presenting with symptoms.
乳腺癌虽不常见，但仍是年轻女性癌症死亡的主要原因。目前，关于 40 岁以下女性乳腺癌的临床表现和特征的研究有限。
这是一项回顾性研究，调查了 145 名年龄在 40 岁以下的乳腺癌女性患者的人口统计学、临床表现、影像学表现和癌症特征。
我们的队列比报道的老年女性具有更具侵袭性的癌症亚型；三阴性占 33.1%，Ki-67 高的占 80%，III 期及以上的占 21.3%。大多数患者来自初级保健医生或妇产科医生，但也有 5.5%的患者最初从急诊室就诊，另有 2.1%的患者为偶然发现。16.6%的患者在怀孕或哺乳期就诊。大多数患者表现为与乳房相关的症状。在我们的高危筛查计划中诊断的 9.1%的患者中，84.6%的癌症在乳房 X 线摄影或同时进行乳房 X 线摄影和 MRI 时被发现。大多数乳腺癌的影像学表现通常令人担忧（82.6%），尽管一些癌症的表现通常为良性。
我们建议对出现乳房相关症状或偶然发现乳房异常的年轻女性进行快速乳房影像学检查，因为与老年女性相比，年轻患者的癌症亚型更具侵袭性，且在就诊时的分级更高。我们还建议在区分可疑症状与妊娠相关的乳房变化时要保持警惕，以尽量减少诊断延误。此外，识别有资格进行高危筛查的患者也很重要，因为筛查患者的癌症发现时的分级低于有症状患者。
