Abstract
Background
Race, access to care, and molecular features result in outcome disparities in triple-negative
breast cancer (TNBC). We sought to determine the role of age in TNBC disparity by
hypothesizing that younger patients receive more comprehensive treatment, resulting
in survival differences.
Methods
The National Cancer Database was used to identify women with unilateral TNBC treated
from 2005 through 2017. Patients were stratified by age (≤40, 41–70, >70); demographics,
clinical characteristics, and treatment factors were compared. Logistic regression
determined factors associated with treatment received. Survival outcomes were analyzed
using a stratified log-rank test.
Results
Of the 168,715 patients, 16,287 (9.6%) were ≤40 years. Patients ≤40 were significantly
more likely to present at higher clinical stage (P < .001) and receive neoadjuvant chemotherapy (NAC, P < .001). Bilateral mastectomy was the most common surgery for patients ≤40 (37%),
whereas partial mastectomy was most often used in patients 41 to 70 years old (48%)
and those >70 (49%) (P < .001). Patients ≤40 years were significantly more likely to undergo both NAC and
mastectomy than those >40 (odds ratio 1.5, both P < .05) despite a greater in-breast tumor response in the youngest patients. Patients
treated with mastectomy and axillary lymph node dissection had inferior survival outcomes
compared to those treated with partial mastectomy and sentinel lymph node biopsy across
all 3 age groups (P < .001).
Conclusion
The clinical characteristics of TNBC differ significantly at the extremes of age,
likely driving treatment decisions. Although patients ≤40 present with a more advanced
disease and appropriately receive NAC, they also undergo more extensive surgery that
does not yield a survival benefit. Further research is needed to determine if age
disparity is due to oncologic factors or patient and provider preferences.
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Article info
Publication history
Published online: August 01, 2022
Accepted:
May 23,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
