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We Need More Breast Cancer Trials For Younger Patients Urge Experts

The poorer survival rates of younger breast cancer patients could be a result of insufficient clinical trials for this age group. This was a conclusion of a major new Cancer Research UK study published online recently in the Journal of the National Cancer Institute (JNCI).

Senior author Dianna Eccles, who heads Cancer Research UK's Southampton Clinical Trials Unit, says in a statement:

"This study adds to the evidence that breast cancer can behave very differently when diagnosed in younger women."

"They may require a different approach to treatment - which isn't necessarily understood from cancer trials in older patients," she explains, urging that more trials should be done in younger women as "research is the key to improving survival" for this group and for developing new treatments specifically for them.

For the study, which was funded by Cancer Research UK and The Wessex Cancer Trust, Eccles and colleagues analyzed data from the Prospective Study of Outcomes in Sporadic and Hereditary Breast Cancer (POSH), which was designed to investigate factors affecting prognosis in younger breast cancer patients, ie between the ages of 18 and 40.

It follows another recent announcement by the charity that more younger women in the UK are being diagnosed with breast cancer, and an earlier report in JAMA that shows a small increase in cases of advanced stage breast cancer among younger American women.

Women under 40 represent less than 5% of breast cancers treated in the UK. It is far more common for the disease to be diagnosed in women who have passed the menopause.

Nearly 3,000 patients aged 40 and under (median age 36) joined the POSH study at 127 UK hospitals between 2000 and 2008, where details of tumor type and characteristics, disease stage, treatment received and outcome were recorded.

The results show that the median tumor size was 22 mm diameter and in half of the patients the cancer had spread to the lymph nodes.

A third of the cancers were estrogen receptor (ER) negative and nearly a quarter were human epidermal growth factor receptor 2 (HER2) positive.

Five year survival was higher for patients with ER positive breast cancers than for patients with ER negative cancers.

But after five years, there is a rapid rise in relapse rates in patients with ER-positive breast cancers who had the usual treatment: chemotherapy following by tamoxifen for five years.

This was "in contrast to patients with ER-negative breast cancers, where risk of death peaked at two years", write the researchers.

The finding is also different to studies of older women that do not show the same steep relapse rate after five years.

Tamoxifen targets estrogen receptors to stop the hormone driving the cancer.

The researchers say if younger patients were given tamoxifen for longer, it might help them, and these results show there is a need to explore questions like this with trials that test different approaches specifically in younger patients.

Overall, breast cancer patients face a dramatically improved prospect of survival today compared with decades ago, says Kate Law, director of clinical research at Cancer Research UK.

But although now we can say generally that women today are "twice as likely to survive their disease for at least 10 years compared to those diagnosed in the 1970s, the same can't be said for younger breast cancer patients," she notes.

And, while new treatments are showing great promise in trials, particularly of new drugs called PARP inhibitors, specifically for cancers caused by faulty BRCA1 or BRCA2 genes in younger women, "there's still so much more we want to do to improve treatment for younger breast cancer patients and ultimately ensure that all women beat their disease," says Law.

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