Management and Outcome of Young Women (≤40 Years) with Breast Cancer in Switzerland

SIMPLE SUMMARY: Data on the outcome and treatment of young women with breast cancer (BC) in Switzerland is scarce. We conducted a retrospective cohort study to evaluate treatment and outcome of women aged ≤ 40 years, diagnosed with stage I-III BC in Switzerland between 2000–2014. We found that the majority of patients were treated according to international guidelines, however we identified differences in quality-of-care score across the two Swiss linguistic/geographic regions (Swiss Latin and Swiss German). Survival was high: 91.4% (95% confidence interval (CI) 90.2–92.5) at 5 years and 83.1% (95% CI 81.2–78.5) at 10 years. After adjusting for multiple clinicopathological factors only tumor characteristics and treatment period remained independently associated with survival. We concluded that national guidelines for young women with BC should be implemented to standardize treatment in Switzerland and awareness should be raised among young women and clinicians that BC does not discriminate by age. ABSTRACT: Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000–2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0–39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59–0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.