Journal of Reproductive Health and Contraception

While the disease affecting younger patients has more aggressive pathological features such as higher histological grade and low expression of endocrine receptors, several studies have shown that young age at diagnosis remains an independent factor associated with a higher risk of relapse and death. It previously reported a large analysis involving 2970 patients who were 50 years or older at the time of breast cancer diagnosis, 315 of whom were 35 years old. They discovered that, regardless of breast cancer subtype, younger patients (those under 35) had a greater chance of relapse. The same group reports a retrospective investigation to further describe this very young group of patients in the article that goes along with this editorial. Younger patients' tumours had more aggressive traits, with a significant p-value for trend according to age for advanced stage (p 14 0.06), higher grade (p 14 0.0007), and greater Ki-67 (p 14 0.02).

Despite this, there was no change in disease-free or total survival. In the two youngest age categories, only 6 and 33 breast cancerrelated occurrences were reported, indicating that the lack of statistical significance could be attributable to sample size difficulties. A big study from Korea, which included 351 and 1092 patients diagnosed at 30 and 30e34 years of age at the time of diagnosis, respectively, found that the risk of death increased by 5% for every 1-year reduction in age, even among patients who were 34 at the time of diagnosis. This emphasises that disparities exist at some level even within this group of extremely young patients, highlighting the obvious truth that age is a continuum, which is commonly overlooked due to the usage of cut-offs. As a result, it appears that the variations reported across dichotomized age groups, whether in tumour characteristics or survival, are just a reflection of modest changes throughout the age continuum.

In two large data sets (>1000 and >2000 patients, respectively), researchers investigated into the effect of age (as a continuum) on the expression of different important molecular abnormalities on primary cancers. It was discovered that, regardless of stage, histological grade, or breast cancer subtype, changes in age had a significant impact on the tumour’s transcriptase. The fact that older patients (those over 50 years old) exhibit more or less comparable tumour phenotypes and disease outcomes suggests that the age continuum becomes less relevant as the woman ages. From a biological standpoint, young women's breast stromal and cellular structures are extremely receptive to hormone and growth factor stimulation in order to undergo the necessary histomorphological modifications for pregnancy and breastfeeding. Because ovarian function begins to deteriorate around the age of 37, it's possible that changes occurring throughout the reproductive years play a role in the biology of cancers that develop during this time. Pregnancy, for example, is known to modify the risk of developing breast cancer, which is elevated in the short term but protects against it in the long run. Evidence suggests that reproductive practises have an impact on the type of breast cancer. High parity, for example, appears to lower the chance of developing endocrine-sensitive breast cancer. Breastfeeding, on the other hand, does not increase the risk of developing an endocrine-sensitive disease but does lower the risk of triple negative breast cancer.

As a result, one may argue that changes in reproductive practises through time and from region to region could explain, at least in part, the differences in breast cancer subtype prevalence. Pregnancy has an impact on the occurrence and type of cancer that is later diagnosed, as well as its behaviour. Indeed, cancers that develop soon after pregnancy tend to be more aggressive and have a worse chance of survival As a result, it's probable that younger breast cancer patients have more aggressive features and a worse prognosis because they're more susceptible to the short-term effects of pregnancy, which appear to contribute to tumour progression. Another noteworthy finding in this study is the high prevalence of highly proliferative oestrogen receptor (ER) e positive tumours (or luminal-B) among the young. Although the prevalence of these phenotypes varies from research to study, the majority of studies have revealed a higher prevalence of luminal-B, HER2-positive, and triple negative carcinomas in young women with breast cancer. The current analysis shows that luminal-B ammo has the highest prevalence.