Comparison between the Young and Elderly Diagnosed Patients of Carcinoma of the Breast

pre-Breast cancer presents a signi�cant health challenge in Pakistan, marked by high incidence rates and speci�c cultural and societal barriers to early detection and treatment. Objective: To compare diagnosed cases of CA breast in younger and older patients in terms of mode of presentation, TNM stage at presentation, histological variety and hormonal status. Methods: In our prospective comparative study conducted at the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur, we included a total of 220 breast cancer patients aged 20 years and above. Patients were strati�ed into two distinct age groups for comparison: younger patients (aged less than or equal to 35 years) and older patients (aged more than 35 years). Modes of presentation, histological types, and hormonal receptor statuses were compared between the both groups. Results: In a study of 220 breast cancer patients with a mean age of 42.97 years, younger patients (≤35 years) constituted 24%, while older patients (>35 years) made up 76%. The most common presentation was lump formation (78.18%), mainly in older patients. Ulceration was evenly distributed across age groups. Histologically, invasive ductal carcinoma Grade III was more frequent in older patients, whereas Ductal Carcinoma In Situ (DCIS) was exclusive to younger patients, underscoring distinct age-related disease patterns. Conclusions: Our study revealed signi�cant age-related differences in breast cancer presentation among Pakistani patients. Older patients (>35 years) predominantly presented with lump formation, suggesting diagnostic delays, while all younger patients (≤35 years) had DCIS, indicating possible early detection or unique tumor biology. Additionally, older patients exhibited higher ER and PR positivity.


M E T H O D S
cancer, while stages I -IV indicate invasive breast cancer requiring various treatments, including surger y, chemotherapy, hormonal therapy, biological therapy, and radiation [9].Understanding the hormonal receptors such as ER, PR, and HER2 NEU and correlating them with the initial TNM staging helps to illuminate the complexity and treatment needs of the disease [10].Breast cancer presents a signi cant health challenge in Pakistan, marked by high incidence rates and speci c cultural and societal barriers to early detection and treatment.Notably, 1 in 9 Pakistani women is at risk of developing breast cancer during her lifetime, re ecting an urgent public health concern.The variations in incidence, risk factors, and presentations within Pakistan demand a focused and comprehensive study.Misconceptions and lack of awareness, often exacerbated by illiteracy, hinder early diagnosis and contribute to worsening prognosis.Moreover, understanding the relationships between variables like age, mode of presentation, histopathological variety, hormonal receptors, and staging within the Pakistani population can lead to more effective, personalized treatment strategies.This research aimed to delve into these complexities speci c to Pakistan, providing insights that could signi cantly impact prevention, early detection, and therapeutic approaches, ultimately contributing to the ght against breast cancer in the country.
In our prospective comparative study conducted at the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur, from August 02, 2022, to February 01, 2023, and approved by the CPSP with reference number CPSP/REU/SGR-2018-032-10124, we included a total of 220 breast cancer patients aged 20 years and above, selected using a non-probability sampling technique.Patients were strati ed into two distinct age groups for comparison: younger patients (aged less than or equal to 35 years) and older patients (aged more than 35 years).This strati cation was based on their age at the time of diagnosis, allowing for a focused comparative analysis between these two demographics.Our inclusion criteria targeted patients who were newly diagnosed with breast cancer during the study period, those who received treatment and followed up at the designated department, and those who provided informed consent.Essential for inclusion was that these patients had complete medical records, detailing the mode of presentation, TNM staging, histological type, and hormonal receptor status.Upon breast cancer diagnosis, eligible patients aged 20 years and above were identi ed.The study's objectives, procedures, and con dentiality concerns were thoroughly explained to potential participants, followed by the collection of informed consent.Initial data collection involved gathering demographic information and speci c breast cancer diagnosis details, including the mode of presentation, TNM staging, histological type, and hormonal receptor status, through a comprehensive review of medical records.Participants in both age groups were then followed up at regular intervals according to their treatment schedules.During each visit, updates on their treatment progress and any changes in health status were recorded.All data were meticulously entered into a secure, electronic database, ensuring the con dentiality and integrity of the information.This process was crucial in capturing the evolving clinical pro le and treatment responses of the participants across both age groups, forming the foundation for an in-depth comparative analysis.We used SPSS version 24.0 to analyze all the data.We calculated the mean and standard deviation for age, and determined frequencies and percentages for the younger (≤35 years) and older (>35 years) age groups, modes of presentation, histological types, and hormonal receptor statuses.To compare these factors between the younger and older groups, we applied the Chi-square test or Fisher's Exact Test, as appropriate.We considered a p-value of less than 0.05 as statistically signi cant.demographic [16].This similarity underscores the need for vigilant monitoring and tailored treatment strategies for yo u n g e r b r e a s t c a n c e r p a t i e n t s , e s p e c i a l l y i n underrepresented groups.Schaffar et al., focusing on young women, found a high prevalence of luminal A and B molecular subtypes, which contrasts with our study's nding of a signi cant triple-negative disease in younger patients [17].This contrast may be attributed to ethnic differences, as well as variations in environmental and lifestyle factors between Switzerland and Pakistan.Alwan et al., highlighted signi cant differences between Iraqi and British breast cancer patients, with Iraqi women presenting younger and with more advanced stages, similar to our ndings [18].This similarity points to a broader trend in breast cancer presentation in developing countries, potentially in uenced by socioeconomic and healthcare system factors.The study performed by Latif et al., in Karachi, Pakistan, also found a higher prevalence of breast cancer in younger women presenting at advanced stages, aligning with our ndings [19].This consistency within the same country underscores the need for targeted breast cancer awareness and screening programs in younger Pakistani women.Moreover, recent ndings underscore the complex relationship between menopausal hormone therapy (MHT) and breast cancer incidence in older women.Studies have revealed that while estrogen therapy alone may reduce breast cancer incidence for women with a prior hysterectomy, estrogen plus progestin therapy increases breast cancer risk, persisting over two decades.This highlights the need for a nuanced understanding of hormone therapy impacts in older women, which may also have implications for our study's observations in the older patient group [20].
In this study, the greater number of older patients (>35 years) compared to younger ones re ects the prevalent trends of breast cancer occurrence in Pakistan, where increased age is a signi cant risk factor.This selection was guided by the natural epidemiology of breast cancer, which shows a higher incidence and detection rate in older populations.Challenges in recruiting an adequate number of younger patients, given their lower incidence rate, contributed to this age disparity.Despite this, our statistical analysis has been carefully adjusted to account for these differences, ensuring the validity of our conclusions.This study's design paves the way for future research to further investigate age-related variations in breast cancer, ideally with more balanced age group representation.Our study's observation of a higher incidence of breast cancer in older Pakistani patients (>35 years) aligns with the ndings of Zeeshan et al., which also reported higher-grade tumors and more aggressive triple hormone receptor-negative phenotypes in younger patients [11].However, unlike Zeeshan et al., who found a signi cant incidence of metastatic disease in younger patients, our study noted a prevalence of early-stage disease in this demographic.This discrepancy could suggest varying disease progression rates or differences in early detection effectiveness across regions.The study performed by Abdel-Razeq et al., in   Our study underscores the nuanced variations in breast cancer presentation among Pakistani patients across different age groups.We observed a higher prevalence of breast cancer in the older age group (>35 years), predominantly presenting with lump formation, indicating potential delays in diagnosis.In contrast, younger patients (≤35 years) exhibited a 100% prevalence of Ductal Carcinoma In Situ (DCIS), suggesting earlier detection or distinct tumor biology.Notable differences were also evident in histopathological types and hormonal receptor status, with older patients showing higher ER and PR positivity.These ndings emphasize the need for agespeci c approaches in breast cancer diagnosis and treatment, highlighting the importance of tailored strategies to improve early detection, effective management, and outcomes in breast cancer care across varying age demographics.

Table 3
compares the hormonal receptor status across age groups.ER and PR positivity is considerably higher in older patients (ER: 68.8%, PR: 68.8%) compared to younger ones, indicating a possible link between hormonal receptor positivity and increasing age.

Table 2
Comparison of histopathological variety between both groups (n=220)

Table 3 :
Comparison of hormonal status between both groups (n=220) developing countries echoes our ndings in terms of the younger age at breast cancer diagnosis [12].Both studies observed more aggressive pathological features in younger patients.However, unlike our study, Abdel-Razeq et al., found older patients more likely to present with advanced-stage disease.This contrast highlights potential differences in healthcare access and screening practices between our study population and the reported cohort.Fernandopulle et al., documented a high prevalence of invasive carcinomas in younger patients, which partially contrasts with our study's nding of 100% DCIS in this age group [13].This difference might re ect variations in genetic predispositions, environmental factors, or diagnostic approaches between Singapore and Pakistan.The study of a large cohort in the National Cancer Database performed PJHS VOL. 5 Issue. 1 January 2024 Copyright © 2024.PJHS, Published by Crosslinks International Publishers