Women under 35 responded to neoadjuvant chemotherapy better than older women, according to research using German studies on 8,949 women with operable or locally advanced, nonmetastatic breast cancer presented today at the 35thannual San Antonio Breast Cancer Symposium.   
The younger group included a greater proportion of triple-negative breast cancer cases (26 percent) than the group of women older than 35 (21 percent).  Luminal A cancers accounted for 19 percent of all cases under 35 and 27 percent of those over 35.
The pathological complete response rate was significantly higher in very young women — 23.6 percent compared with 15.7 percent among older women. This difference was amplified in young women with triple-negative breast cancer and those with luminal-like breast cancer.
Breast cancer might be biologically different in very young women, even those who are hormone-positive, according to Sibylle Loibl, M.D., Ph.D., an associate professor at the University of Frankfurt in Germany and the lead author of the paper. 
Researchers found no difference in disease-free survival according to age among those patients who achieved a pathological complete response. However, disease-free survival was significantly worse among young women who did not achieve a pathological complete response.
The younger group included a greater proportion of triple-negative breast cancer cases (26 percent) than the group of women older than 35 (21 percent).  Luminal A cancers accounted for 19 percent of all cases under 35 and 27 percent of those over 35.
Luminal-like cancers tend to be estrogen-positive; either progesterone-positive or progesterone-negative; HER2-negative; and with low Ki67.
“Young women with breast cancer are rare, and some data indicate that their prognosis is worse than it is for older women,”  Loibl said.  Tumors in young women are more likely to be triple-negative.
Loibl says young women with TNBC and luminal-like cancers will both benefit from neoadjuvant chemotherapy.

Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.
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