University of Oulu

Karihtala P, Jääskeläinen A, Roininen N, et al, Real-world, single-centre prospective data of age at breast cancer onset: focus on survival and reproductive history. BMJ Open 2021;11:e041706. doi: 10.1136/bmjopen-2020-041706

Real-world, single-centre prospective data of age at breast cancer onset: focus on survival and reproductive history

Saved in:
Author: Karihtala, Peeter1; Jääskeläinen, Anniina2; Roininen, Nelli2;
Organizations: 1Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre, University of Helsinki, Helsinki, Finland
2Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Department of Oncology and Radiotherapy, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: BMJ, 2021
Publish Date: 2021-04-30


Objectives: Being either young or old at the time of breast cancer diagnosis has been suggested as an indicator of a poor prognosis. We studied the effect of age at breast cancer onset in relation to survival, focusing in particular on biological subtypes and reproductive anamnesis.

Design, setting and participants: Patients with early breast cancer (n=594) treated in a Finnish University Hospital during 2003–2013 were prospectively collected and followed in median 102 months.

Results: Patients with luminal A-like breast cancer were older than the patients with luminal B-like (HER2-positive) (p=0.045) or patients with the HER2-positive (non-luminal) subtype (p=0.029). Patients ≥70 years received substantially less adjuvant chemotherapy (p=1.5×10⁻⁹) and radiotherapy (p=5.9×10⁻⁷) than younger women. Nevertheless, the estimated 10-year breast cancer-specific rates of survival were 84.2%, 92.9% and 87.0% in age groups <41 years, 41–69 years and ≥70 years, respectively, with no statistical difference (p=0.115). Survival rates were also comparable between the three age groups when assessed separately in different biological subtypes, and for patients with metastatic breast cancer there was similarly no difference between the age groups. Later menarche (p=5.7×10⁻⁸) and high parity (p=0.000078) correlated with increased age at breast cancer diagnosis, but, according to the patients’ oestrogen receptor (ER) status, only among ER-positive patients.

Conclusions: Despite the suggested undertreatment of older patients, we report excellent long-term outcomes in all age groups in this prospective cohort. Later endogenous endocrine exposure may cause delay in breast cancer onset, but the exact biology behind this phenomenon is so far unclear.

see all

Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 11
Issue: 1
Article number: e041706
DOI: 10.1136/bmjopen-2020-041706
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.