Breast Cancer in Young Women about 87 Cases in the General Surgery Department CHU Gabriel Touré ()
1. Introduction
Breast cancer is a malignant neoformation that develops at the expense of the various constituents of the mammary gland [1]. Breast cancer accounts for 11.6% of cancer incidence. An estimated 2.1 million women are diagnosed with breast cancer. It is the most common in 154 of the 185 countries covered by GLOBOCAN 2018 and is the 5th leading cause of cancer death in women with 15% of deaths due to the disease [2].
For a long time, breast cancer was linked to a more or less advanced age. However, in recent literature, breast cancer is increasingly diagnosed in young people, its frequency is estimated at 7% of all cases of breast cancer. Thus, several studies have highlighted a number of factors involved in the etiology of this cancer. Among the main factors studied to date are endogenous and exogenous hormonal factors, factors related to reproduction, genetic and health factors, and finally factors related to lifestyle and nutrition [3].
The age threshold that should be considered as “young age” associated with a higher frequency of the above characteristics is not very clear in the literature, varying from 35 to 40 or even 45 years. In this manuscript, we have chosen the age of 40 as the threshold [4].
In France, breast cancer is the most common cancer in women with a constantly increasing incidence for 20 years, the number of new cases estimated in 2015 is 54,062 and occurs in 22% of women under 40 years old. In 7 years, 2083 patients with invasive breast cancer have been treated in the Gynecology department of the University Hospital of Tours in France. Among these women, 7.4% were less than or equal to 40 years old (7.4%) [5].
Miss JABA Sihan had a 40% incidence of breast cancer in women under 40 in Rabat, Morocco [6].
In Mali in 2017 Zeinabou Coulibaly found 19.68% of breast cancer in women under 40 [7].
As with other breast cancers, the diagnosis of breast cancer in young women is based on a careful clinical examination, mammography, breast ultrasound, and especially a histological examination of the tumor.
The management is consensual and is designed in a multidisciplinary consultation meeting which makes it possible to validate the therapeutic options.
Only early detection improves the prognosis of this cancer. This requires self-examination but also regular episodes of mammography [8].
Detection of metastatic disease at the subclinical stage does not improve survival. But early detection of local recurrences has a beneficial impact on survival [9].
In Mali, few studies have been carried out on breast cancer in young women, which motivated us to initiate this work.
2. Objective
To determine the frequency of breast cancer in young women; to describe the risk factors for breast cancer in young women; to develop the diagnostic approach of the disease; to identify the different therapeutic strategies.
3. Methodology
This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years, and included all cases of breast cancer in women aged 40 and under, operated and with a histological diagnosis. Data confidentiality was respected. The names of the patients do not appear in any document relating to the results of this study.
4. Results
During our study we found 265 patients operated on for breast cancer, 87 of whom were aged 40 and under, at 32.83% of cases.
The age group [36 - 40 years] was the most frequent at 46%. The average age was 33.21 years with a standard deviation of 6.9 and extremes of 15 and 40 years (Table 1).
The family history of breast cancer was found in 09 cases at 10.3% (Table 2).
The menarche was late (greater than or equal to 16 years) in 9 of our patients (Table 3)
The majority of our patients had 4 as parity in 20.7% of cases followed by 03 and 5 which represented respectively 17.2% and 16.1% of cases (Table 4).
75.9% of our patients had consulted for a breast mass (Table 5).
There was breast pain in 57.5% of cases (Table 6).
There was skin ulceration in 33.3% of cases (Table 7).
The masses were localized in 47.1% of cases in the supero-external quadrant followed by the supero-internal quadrant in 11.5% of cases (Table 8).
The mean height was 07.6 cm with extremes of 1 and 27 cm and a standard deviation of 6.01 (Table 9).
ACR3 was the most represented, 26.4% of cases (Table 10).
Breast ultrasound was not performed in 34.5% of patients. Ella was contributory in 65.5% (Table 11).
Infiltrating carcinoma of the non-specific type was the most represented in 87.3% of cases, followed by breast carcinoma which is at 5.7% (Table 12).
SBR-EE grade 2 was the most represented in 50.6% of cases (Table 13).
The triple negative was the most represented at 42.9% (Table 14).
60% des métastases étaient osseuse suivit du foie et des poumons qui représentait chacun 20% des cas (Table 15).
Stage 2 was the most represented with 47.2% of cases followed by stage 3 which represented 37.9% of cases (Table 16).
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Table 1. Distribution of patients according to age (in years).
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Table 2. Distribution of patients according to family history of breast cancer.
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Table 3. Distribution of patients according to age of onset of menarche.
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Table 4. Distribution of patients according to parity.
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Table 5. Distribution of patients according to the reason for consultation.
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Table 6. Distribution of patients according to the existence of breast pain.
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Table 7. Distribution of patients according to the existence of skin ulceration.
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Table 8. Distribution of patients according to tumor location.
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Table 9. Distribution of patients according to tumor size.
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Table 10. Distribution of patients according to the result of the mammography.
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Table 11. Distribution of patients according to the result of the breast ultrasound.
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Table 12. Distribution of patients according to histology result.
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Table 13. Distribution of patients according to SBR-EE grade.
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Table 14. Distribution of patients according to immunohistochemistry result.
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Table 15. Distribution of patients according to site of metastasis.
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Table 16. Distribution of patients according to TNM stage.
Chemotherapy was performed in 90.2% of cases (Table 17).
6.9% of patients had benefited from radiotherapy (Table 18).
10 patients or 11.5% had benefited from hormone therapy against 88.5% (Table 19).
The most performed type of surgery was mastectomy associated with axillary dissection, i.e. in 75.9% of cases (Table 20).
The postoperative course was simple in 89.7% of cases. A recurrence was found in 4.6% of cases (Table 21).
5. Comments
We found a prevalence of 32.8% of breast cancer in young women (Table 22), which is comparable to those of Samira in Marrakech [10] and Bouzid in Tunisia [11] who had respectively 18.6%, 10% and 7.5%; which is however different from the study by Znati et al. in Morocco [9].
11.5% of patients in our study had a personal history of breast pathology which was not proportional to those found by Bouzid et al. in Tunisia [11] and Jaba in Morocco [12]. Our study was statistically proportional to that of Samira in Marrakech [10] in 2019 (Table 23).
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Table 17. Distribution of patients according to the feasibility of chemotherapy.
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Table 18. Distribution of patients according to the feasibility of radiotherapy.
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Table 19. Distribution of patients according to the feasibility of hormone therapy.
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Table 20. Distribution of patients according to the type of surgery performed.
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Table 21. Distribution of patients according to postoperative course.
In our series, we had 9 cases of family history of breast cancer at 10.3% proportional to 19.4% in the Senegalese series of Gueye et al. [13], to 15.3% in the Tunisian series of Bouzid [11] and 11.4% of the French series by M Guendouz et al. [14]. We do not have technology for the detection of genetic factors of breast cancer in Mali (Table 24).
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Table 23. Personal history of breast disease.
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Table 24. Family history of breast cancer.
The study by Khanfir et al. in Tunisia found a predominance of stage III with 16.3% (Table 25), which is proportional to our study and that of M Guendouz et al. in France with 37.9% and 38% respectively.
Thus, grade II of the SBR classification represented 50.6% of cases in our series (Table 26 & Table 27). This is consistent with data from Bouzid in Tunisia. Grade 3 was the most represented in the study by Fleurier et al. [17] in France and that of Ayyad [16] in Morocco, i.e. in 49% of cases for each.
In our series, we found a predominance of mastectomy associated with axillary dissection (MCA). They were found in 66 patients 75.9% (Table 28). This is related to the study by Jaba in Morocco [12] on 23 cases of breast cancer in young women, shows that 82% of patients had benefited from a mastectomy plus axillary dissection. The study by Bouzid et al. [11] had a rate of mastectomy plus axillary dissection in 63.5% of cases, which is proportional to ours.
Our study found 90.8% of cases of use of chemotherapy as treatment (Table 29). This result is in line with the results of other authors such as Guendouz in France [14] with p = 0.1253, Bouzid in Tunisia with a p = 0.4071 and Gueye who found 89% of chemotherapy benefited in his study, with p = 0.2492. This could be explained by the sample size.
In our study, 11.5% of patients benefited from hormonal treatment (Table 30). This rate is relatively low compared to those of other authors such as Khanfir
Tunisie [15], Guendouz France [14] and Samira Maroc [10] who had 50%, 36.1% and 49% respectively. This is due to the difficulty of access of our patients to hormone therapy.
6. Conclusion
Breast cancer is a real public health problem, the number of new cases continues to increase in our country. We collected 87 cases of breast cancer in women under 41 years old. Young age is often associated with anatomo-clinical and evolutionary parameters of poor prognosis, among which we can cite diagnostic delay, the frequency of advanced forms with a larger tumor size, more frequent histological lymph node involvement, a higher histological grade. Often high, more frequent locoregional and distant recurrences, and finally poor overall survival.