INTRODUCTIONWhilst only 5.5% to 7% of breast cancer occurs in women less than 40 years of age in the West, the incidence has been reported in up to 18% in Asian population. This study seeks to evaluate our unit's experience in breast cancer in young women.

MATERIALS AND METHODSA retrospective review of our database identified women with newly diagnosed breast cancer from January 2006 to February 2011. Patient demographics, clinical presentation, imaging and pathological findings and treatment received were determined.

RESULTSOut of a total of 1160 women with breast cancer, 135 (11.6%) were under 40 years of age and made up our study population. The most common presentation was a self-detected breast lump. Most patients did not have a positive family history. Mammography demonstrated abnormal findings in 78% of patients. Ultrasound was very sensitive in the evaluation of a breast lump and demonstrated abnormal findings in 95%. Out of 129 women, 40 (31%) underwent breast-conserving surgery of which 5 (12.5%) proceeded to mastectomy due to involved margins. Also, 89 out of 129 women (69%) underwent mastectomy of which 19 (21.3%) had immediate reconstruction. Of a total of 121 primary resections, 94% were invasive ductal carcinoma while 15.5% were pure ductal in-situ carcinomas. The majority (61.2%) showed high grade disease.

CONCLUSIONMost young breast cancer patients present with a self-detected breast lump and do not have a positive family history. A strong clinical index of suspicion and appropriate breast imaging workup are useful for the early and accurate diagnosis of breast cancer in young women.

Adolescent ; Adult ; Age Factors ; Breast Neoplasms ; diagnosis ; epidemiology ; surgery ; Female ; Hospital Units ; Humans ; Retrospective Studies ; Singapore ; Young Adult

OBJECTIVE: To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings. MATERIALS AND METHODS: Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23 72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators' experience, and the retrieval rate for calcifications. RESULTS: For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%) ], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by longterm follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47). CONCLUSION: In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. Falsenegative findings were frequent during the operators' learning period.
Adult ; Aged ; Biopsy, Needle/*methods/standards/statistics & numerical data ; Breast/*pathology/surgery ; Breast Neoplasms/*diagnosis/epidemiology/surgery ; Calcinosis/*diagnosis/epidemiology/surgery ; Carcinoma in Situ/*diagnosis/epidemiology/surgery ; Diagnosis, Differential ; Disease Progression ; False Negative Reactions ; Female ; Follow-Up Studies ; Human ; Incidence ; Mammography/statistics & numerical data ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Time Factors ; Treatment Outcome

OBJECTIVES: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
Adult ; Aged ; Breast Neoplasms/diagnosis/mortality/*surgery ; Cohort Studies ; Female ; Humans ; Mastectomy, Radical/mortality ; Middle Aged ; *Mortality ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors

PURPOSE: The present study aims to evaluate the prevalence of unmet needs among breast cancer survivors, to assess the relationships between unmet needs and depression and quality of life, and to explore the extent to which unmet needs of breast cancer patients relate to the time elapsed since surgery. MATERIALS AND METHODS: Among 1,250 eligible patients who participated in the study, 1,084 cases (86.7%) were used for analysis. Clinicopathological and social parameters were reviewed and the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy-Breast cancer instrument, and Beck Depression Inventory were administered. The frequency of unmet needs, the association between unmet needs and depression and/or quality of life (QOL) and the impact of the time elapsed since surgery on the patients' unmet needs were analyzed. RESULTS: The highest levels of unmet needs were found to be in the health system and information domain. Patients with a survival duration of less than 1 year since surgery showed significantly higher unmet needs in all need domains except the sexuality domain (p<0.001) than participants in the other groups. Patients with a survival duration of 1-3 years also experienced significantly higher psychological and information needs than long-term survivors (>5 years). In addition, unmet needs were significantly associated with depression (p<0.001) and QOL (p<0.001). CONCLUSION: The present study demonstrated that long-term breast cancer survivors had a significantly lower level of unmet needs than patients with survival duration of less than 3 years after surgery and patients with survival duration of less than 1 year since surgery suffered the greatest unmet needs. QOL might be enhanced if interventions are made for specific unmet needs of each patient group.
Adult ; Breast Neoplasms/*mortality/*psychology/surgery ; Cross-Sectional Studies ; Depression/diagnosis/mortality ; Female ; Health Services Accessibility/*statistics & numerical data ; Humans ; Middle Aged ; Needs Assessment/*statistics & numerical data ; Prevalence ; *Quality of Life ; Republic of Korea/epidemiology ; *Social Support