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Breast Malignancies in Children: Presentation, Management, and Survival

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Pediatric breast malignancies are rare, and descriptions in the literature are limited. The purpose of our study was to compare pediatric and adult breast malignancy.

Methods

We performed a retrospective cohort study using the National Cancer Data Base comparing patients ≤21 years to those >21 years at diagnosis (1998–2012). Generalized linear models estimated differences in demographic, tumor, and treatment characteristics. Cox regression was used to compare overall survival.

Results

Of 1,999,181 cases of invasive breast malignancies, 477 (0.02%) occurred in patients ≤21 years. Ninety-nine percent of adult patients had invasive carcinoma compared with 64.8% of pediatric patients with the remaining patients having sarcoma, malignant phyllodes, or malignancy not otherwise specified (p < 0.001). Pediatric patients were twice as likely to have an undifferentiated malignancy [relative risk (RR) 2.19; 95% confidence interval (CI) 1.72–3.79]. Half of adults presented with Stage I disease compared with only 22.7% of pediatric patients (p < 0.001). Pediatric patients were 40% more likely to have positive axillary nodes (RR 1.42; 95% CI 1.10–1.84). Among patients with invasive carcinoma, pediatric patients were more than four times as likely to receive a bilateral than a unilateral mastectomy compared with adults (RR 4.56; 95% CI 3.19–6.53). There was no difference in overall survival between children and adults.

Conclusions

Pediatric breast malignancies are more advanced at presentation, and there is variability in treatment practices. Adult and pediatric patients with invasive carcinoma have similar overall survival.

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Notes

  1. StataCorp. 2011. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.

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Acknowledgement

The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. National Institutes of Health. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used or for the conclusions drawn from these data by the investigators. Morgan Richards and Kenneth Gow had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author’s Contributions

The following authors have made substantial contributions to the intellectual content through conception, design of the study, and critical revision of the manuscript: Kenneth Gow, MD, Adam B. Goldin, MD, MPH, John Doski, MD, Melanie Goldfarb, MD, Jed Nuchtern, MD, Monica Langer, MD, Elizabeth A. Beierle, MD, Sanjeev Vasudevan, MD, Sara Javid, MD. The following individuals have made substantial contributions to the intellectual content through conception and design of the study, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content: Morgan K. Richards, MD, MPH, Sara Javid, MD.

Disclosure

We have no potential conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, WA, 98195, USA

    Morgan K. Richards MD, MPH & Sara H. Javid MD, FACS

  2. Department of General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, WA, 98195, USA

    Morgan K. Richards MD, MPH, Adam B. Goldin MD, MPH, FACS & Kenneth W. Gow MD, FACS

  3. University of Alabama, Birmingham, Birmingham, AL, 35233, USA

    Elizabeth A. Beierle MD

  4. Methodist Children’s Hospital of South Texas, San Antonio, TX, 78229, USA

    John J. Doski MD

  5. John Wayne Cancer Institute, Santa Monica, CA, 90404, USA

    Melanie Goldfarb MD

  6. Maine Children’s Cancer Program, Scarborough, ME, 04074, USA

    Monica Langer MD

  7. Baylor College of Medicine, Houston, TX, 77030, USA

    Jed G. Nuchtern MD & Sanjeev Vasudevan MD

  8. Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, WA, 98105, USA

    Morgan K. Richards MD, MPH

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  1. Morgan K. Richards MD, MPH
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Corresponding author

Correspondence to Morgan K. Richards MD, MPH.

Appendix 1 Histological classification of pediatric and adult breast cancer.

Appendix 1 Histological classification of pediatric and adult breast cancer.

Breast cancer was defined as the following:

  1. 1.

    Invasive ductal carcinoma (International Classification of Disease for Oncology, version 3 [ICD-O-3]: 8201, 8500, 8521, 8522, 8523,8541; Behavior 3)

  2. 2.

    Invasive lobular carcinoma (ICD-O-3: 8524/3)

  3. 3.

    Invasive carcinoma of other subtypes (ICD-O-3: 8010, 8050, 8200, 8243, 8255, 8260, 8263, 8320, 8340, 8341, 8343, 8380, 8430, 8480, 8481, 8502, 8504, 8525, 9580, 8020, 8021, 8022, 8030, 8031, 8032, 8033, 8035, 8140, 8141, 8230, 8245, 8246, 8345, 8490, 8510, 8512, 8513, 8514, 8530, 8560, 8562, 8570, 8571, 8572, 8573, 8574, 8575; Behavior 3)

  4. 4.

    Sarcoma (ICD-O-3: 8800, 8801, 8802, 8804, 8805, 8811, 8814, 8830, 8832, 8840, 8852, 8853, 8854, 8855, 8858, 8891, 8894, 8895, 8896, 8901, 8910, 8920, 8933 , 8935, 8963, 8980, 8982, 8990, 9540, 9560, 9581; Behavior 3)

  5. 5.

    Phyllodes (ICD-O-3: 9020/3)

  6. 6.

    Malignancy NOS (ICD-O-3: 8000, 8001, 8003, 8940; Behavior 3).

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Richards, M.K., Goldin, A.B., Beierle, E.A. et al. Breast Malignancies in Children: Presentation, Management, and Survival. Ann Surg Oncol 24, 1482–1491 (2017). https://doi.org/10.1245/s10434-016-5747-5

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