INTRODUCTION
Breast cancer is common in women but can also occur in a much smaller percentage of men. Breast cancer often occurs in old age (post-menopausal age) [1,2]. Based on the data from the Global Cancer Observatory in 2020, it is known that breast cancer is the newest cancer case in the world with a proportion of 11.7% (2.26 million cases) and has the second-highest mortality rate after lung cancer with a proportion of 6.9% (685 thousand deaths) [3].
Breast cancer in young women is cancer in the breast found in women diagnosed at the age of < 40 years. So far, breast cancer in young women has a relatively lower percentage of incidence compared to older women
(≥ 40 years). However, the prognosis in young women diagnosed with breast cancer is relatively poorer and has a significant impact on the sufferer’s survival. Breast cancer cases in young women are typically diagnosed more slowly because of low suspicion, are often diagnosed at an advanced stage, and have biological characteristics of more aggressive and progressive cancer [4].
Specific studies that discuss the prevalence of breast cancer in young women in South Sumatra are rarely conducted. This study can provide up-to-date data on the issue because it contains the characteristics of breast cancer in young female patients, which include sociodemographic and clinicopathological characteristics of breast cancer, in 2019–2020 at Dr. Mohammad Hoesin General Hospital Palembang.
Characteristics of Breast Cancer in Young Female Patients in Dr. Mohammad Hoesin General Hospital Palembang
Atik Diah Mutiara Ningsih
1, Nur Qodir
2*, Ahmat Umar
2, Mulawan Umar
2, Puji Rizki Suryani
3, Citra Dewi
41 Medical Undergradute, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
2 Surgery Department, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
3 Psychiatry Department, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
4 Anatomical Pathology Department, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
A R T I C L E I N F O Received : 31 January 2022 Reviewed : 04 March 2022 Accepted : 01 August 2022 Keywords:
breast cancer, characteristic, women, young age
A B S T R A C T
Background: Breast cancer has had the highest mortality and morbidity globally in recent years.
Breast cancer in young women presents with biological characteristics of more aggressive cancer, generally detected at advanced stage and a poorer prognosis. This study aimed to determine the characteristics of the incidence of breast cancer in young female patients at Dr. Mohammad Hoesin General Hospital Palembang in 2019–2020.
Methods: This study is descriptive observational study conducted in October–November 2021.
After having ethical approval from the Institutional Review Committee, research data were obtained from the medical records of young female patients diagnosed with breast cancer from January 1, 2019 to December 31, 2020. Samples were collected by using total sampling with the patient’s young age limit of fewer than 40 years.
Results: The incidence of breast cancer was 20.9% (169 patients). The number of samples in this study was 120. Sociodemographic characteristics include the age range of 35–39 years around 63.3% (76 people), the highest education level of senior high school around 35% (42 people), not working around 73.3% (88 people), and living in the Palembang City area around 47.5%
(57 people). Clinicopathological characteristics include the stage at the first diagnosis of stage IIIB about 46.7% (56 people), luminal B clinical subtype about 60% (72 people), and most histopathological type of invasive carcinoma of no special type about 88.3% (106 people).
Conclusions: The incidence of breast cancer in young women is less than in older women but has worse cancer characteristics.
*Corresponding author:
Nur Qodir
Surgery Departement, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia.
dokterhakim@gmail.com
Characteristics of Breast Cancer in Young Female Patients
METHODS
Ethical ApprovalThe research data were obtained from the Medical Record Installation of Dr. Mohammad Hoesin General Hospital Palembang after having ethical approval from the Institutional Review Committee of the Faculty of Medicine, Universitas Sriwijaya (207/KEPKFKUNSRI/2021).
The data used comes from the medical records of young female patients diagnosed with breast cancer from January 1, 2019, to December 31, 2020. In this study, there was no informed consent from the respondent because no intervention was carried out and all personal data of the respondent were kept confidential.
Participants and Settings
This study was conducted on women who had breast cancer for the first time at a young age (< 40 years) in Dr. Mohammad Hoesin General Hospital Palembang from January 1, 2019, to December 31, 2020. This descriptive observational study was conducted in October–November 2021. Sample was excluded if it was accompanied by cancer in other organs that were not metastatic from breast cancer. The data were taken using a total sampling technique. The age limit used in this study is less than 40 years. The software used to process the data in this study includes Microsoft Office Excel 2013 and SPSS (Statistical Package for Social Sciences) 26.0.
RESULTS
The result shows that the number of female patients diagnosed with breast cancer at a young age (< 40 years) at Dr. Mohammad Hoesin General Hospital Palembang, in 2019–2020, was 20.9% (169 people) of all breast cancer cases (Table 1). Furthermore, according to the variables observed in this study, 120 were taken from 169 people with complete medical record data.
Sociodemographic characteristics (Table 2) included age at first diagnosis, education, occupation, and place of residence. About 76 person (63,3%) were diagnosed at 35–39 years. The highest level of education was senior high school (42 person (35%). Most of the samples (88 people(73,3%) did not work or housewives. In addition, it was found that around 47.5% (57 people) live in the Palembang City area.
Clinicopathological characteristics of breast cancer (Table 3) in young women (< 40 years) in Dr. Mohammad Hoesin General Hospital Palembang include a stage at first diagnosis, clinical subtype, and histopathological type. About 79 people (65,8%) were diagnosis at stage III and specifically at stage IIIB (56 people (46.7%)).
Most of the clinical subtype was the luminal B subtype (72 people (60%)). Most common histopathological type
DISCUSSION
It was found that breast cancer case in young women (< 40 years) were lower than those in older women (≥ 40 years), with an incidence proportion of about 20.9% (169 people). Various studies that analyzed the incidence of breast cancer in young women (< 40 years) also showed the same thing, where breast cancer in the younger age group (< 40 years) was relatively less common [5,6]. Globally, the incidence of breast cancer in young women was influenced by technological developments and knowledge and the level of awareness in screening and reporting cases of breast cancer, especially in young women [7].
Sociodemographic characteristics were observed to see the frequency distribution of age at first diagnosis, education level, occupation, and place of residence of each sample in this study. Most of the young women diagnosed as breast cancer were at 35–39 years old, with a proportion of 63.3% (76 people). Age was one of the risk factors for breast cancer, the older a woman the more inceasing potential for that woman for having breast cancer. Various studies that had been conducted also showed similarity to the result of this research.
Research conducted at the Surgical Oncology Subdivision of Sanglah Central General Hospital, Denpasar, in 2018 stated that the highest age range in the young age group was 34–39 years old with a proportion of 47.2%
(34 people) [8].
The level of education that had been taken reflects the person’s level of knowledge and way of thinking. Health was often associated with a person’s education level, where the higher the level of education, the higher the awareness for a people to take care of their health [4]. The majority of sample had completed education up to senior high school, with a proportion of 35% (42 people). In previous studies, most young female breast cancer patients had a low level of education. However, variations in these results may be due to regional differences and the average income level of each region [4,9,10].
Occupation played an essential role in supporting the financial condition, which also supports the social and economic status of the household in society. An excellent financial condition made it easier for a person to perform screening or early detection of various diseases. Most of the samples in this study were housewives or did not have an occupation, with a proportion of 73.3% (88 people). Various research results also state that female breast cancer patients do not work or are housewives [9–11].
Palembang City is the area most occupied by the samples, 47.5% (57 people). Dr. Mohammad General Hospital Hoesin is a type A hospital located in Palembang City, South Sumatra, and is one of the leading referral
A T I K D I A H M U T I A R A N I N G S I H , E T A L
Table 2. Sociodemographic characteristics of young female breast cancer patients (< 40 years)
Sociodemographic Characteristics n % Age (years)
< 25 3 2.5
25–29 6 5
30-34 35 29.2
35-39 76 63.3
Level of Education
Primary school 18 15
Junior High School 40 33.3
Senior High School 42 35
University 20 16.7
Job Status
Not working/housewife 88 73.3
Working 32 26.7
Civil servant 10 8.3
Private-employee 10 8.3
Others 12 10
Residence
Palembang 57 47.5
Ilir Timur I 8 6.7
Ilir Timur II 5 4.2
Seberang Ulu I 1 0.8
Ilir Barat I 5 4.2
Ilir Barat II 6 5
Sukarami 1 0.8
Sako 7 5.8
Kertapati 3 2.5
Gandus 3 2.5
Kemuning 8 6.7
Plaju 4 3.3
Bukit Kecil 1 0.8
Sematang Borang 1 0.8
Alang-alang Lebar 2 1.7
Kalidoni 2 1.7
Sociodemographic Characteristics n %
Outside Palembang 56 46.7
Ogan Ilir 6 5
OKU 1 0.8
OKU Timur 4 3.3
OKU Selatan 3 2.5
OKI 4 3.3
Empat Lawang 2 1.7
Lahat 1 0.8
Banyuasin 10 8.3
Musi Banyuasin 6 5
Lubuk Linggau 2 1.7
Muara Enim 10 8.3
Prabumulih 3 2.5
Musi Rawas 4 3.3
Outside South Sumatra 7 5.8
Abbreviations: n, number of patients; %, percentage of patients
Table 3. Clinicopathological characteristics of breast cancer in young female breast cancer patients (< 40 years)
Characteristics of Breast Cancer n % Stage
0 (in situ) 0 0
I 0 0
IIA 4 3.3
IIB 9 7.5
IIIA 19 15.8
IIIB 56 46.7
IIIC 4 3.3
IV 28 23.3
Clinical Subtype
Luminal A 23 19.2
Luminal B 72 60
HER2-enriched 4 3.3
Triple-negative 21 17.5
Histopathological Type
Invasive carcinoma of no special
type (NST) 106 88.3
Invasive lobular carcinoma 5 4.2 Mixed invasive ductal
and lobular carcinoma 5 4.2
Mucinous carcinoma 4 3.3
Abbreviations: HER2, Human Epidermal Growth Factor Receptor 2 Table 1. The incidence of breast cancer
Year < 40 years ≥ 40 years
Total
n % n %
2019 101 20.4 393 79.6 494
2020 68 21.7 246 78.3 314
Abbreviations: n, number of patients; %, percentage of patients
Most of the young female breast cancer patients at Dr. Mohammad Hoesin General Hospital Palembang, in 2019–2020, were diagnosed with stage IIIB, with a proportion of 46.7% (56 people). Breast cancer staging was classified according to the tumor, node, and metastasis (TNM) method using American Joint Committee on Cancer (AJCC) guidelines [1,13,14]. Young women diagnosed with breast cancer generally had an advanced stage of cancer caused by various factors, including low public awareness about the dangers and impacts of breast cancer, inadequate health facilities, and social and economic factors in the community in an area [4,15].
The most clinical subtype in young women who had breast cancer in Dr. Mohammad Hoesin General Hospital Palembang in 2019–2020 was luminal B, with a proportion of 60% (72 people). Several previous studies had confirmed luminal B as the most common clinical subtype of breast cancer found in several regions in Indonesia. In terms of clinical information, age was known to be associated with these clinical subtypes of breast cancer. Therefore, higher luminal B positivity rate in Indonesian patients warranted further research [8,16].
Previous research at Dr. Mohammad Hoesin Palembang also stated that the most clinical subtype of breast cancer in 2014–2016 was Luminal B [6]. Luminal B in all breast cancer cases was generally rare (only about 10–20% of cases). However, they had a relatively lower survival rate than other clinical subtypes such as luminal A [1,17]. In the latest AJCC guidelines, information on the analysis of ER, PR, and HER2 had been included as a component in determining patient prognosis by considering biological parameters to view prognostic information more accurately [18].
Histopathological type of breast cancer that occured in young women in Dr. Mohammad Hoesin Palembang in 2019–2020 was invasive type (invasive carcinoma of no special type) in 106 people (88.3%). This type had a great potential to metastasized to other organs or body parts such as the brain, bones, lungs, and liver [1,19].
CONCLUSIONS
The incidence of breast cancer in young women was 20.9% (169 people). Based on the results of the study, the majority of patients were housewives who did not work dan lived in the Palembang City area with clinicopathological characteristics that lead to aggressive cancer and poor prognosis.
DECLARATIONS
Ethics ApprovalThe research data were obtained from the Medical Record Installation of Dr. Mohammad Hoesin General
Hospital Palembang after taking ethical approval from the Institutional Review Committee of the Faculty of Medicine, Universitas Sriwijaya (207/KEPKFKUNSRI/2021).
Competing interest
The authors declare no competing interest in this study.
Acknowledgment None
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