br Conclusion Breast cancer remains a rare malignancy among
Conclusion: Breast cancer remains a rare malignancy among pediatric patients. Although black patients were found to have more noncarcinomatous tumors with less advanced disease, this did not confer a survival advan-tage.
Type of study: Retrospective cohort study.
Level of evidence: Level III.
Pediatric breast cancer comprises less than 0.1% of all breast cancers and less than 1% of pediatric cancers overall [1–5]. The incidence of breast cancer is estimated to be 0.2–0.8/100,000 for females less than 20 years old [6,7]. Despite being a rare disease in this population, when compared with adults, breast cancer has been shown to be more aggressive in the pediatric M3814 (nedisertib) [8–11], and therefore con-tinues to be a topic of interest in the pediatric surgical literature. Previ-ous reports on adolescent breast cancer using the SEER and NCDB datasets provided descriptive analysis of pediatric breast cancer [1,6].
☆ Author Contribution: Study Conception and Design: ML Westfal, CM KelleherAcquisition of Data: ML WestfalAnalysis and Interpretation of data: ML Westfal, DC Chang, CM KelleherDrafting of Manuscript: ML WestfalCritical Revision of Manuscript:
ML Westfal, DC Chang, CM Kelleher
☆☆ How this paper will improve care: Despite being a rare disease, one-fifth of patients with pediatric breast cancer die secondary to their disease. Clinical management guide-lines should focus on early diagnosis and black patients, who despite having less aggressive disease, do not have a survival advantage.
In this study, we add to the existing literature by reporting on patient specific variables such as race, histology, and hormone receptor status and their impact on survival for pediatric patients with malignant breast disease.
1.1. Study population
Patients were identified using the Surveillance, Epidemiology, and End Results (SEER) database. A retrospective cohort study was per-formed and included all pediatric patients 19 years and younger with malignant breast tumors diagnosed between 1973 and 2014. Prior to analysis, duplicate patients were removed.
Patient and tumor demographics were extracted from the database. Initially, patient covariates included race (white, black, other (American Indian/AK Native, Asian/Pacific Islander)), gender (male, female), age at
diagnosis, and year of diagnosis. The SEER database designates patients Table 2
as Hispanic or non-Hispanic in a separate ethnicity variable. Analysis of Tumor demographics.
this variable by race revealed that all but one Hispanic patient was
N % of total cases
coded into the white race variable. Therefore, for the purposes of analy-
sis, race was recoded into black and nonblack (white, Hispanic, other).
Tumor demographics initially included grade (well differentiated, mod- Localized 78 65.0%
erately differentiated, poorly differentiated, undifferentiated), stage (in Regional 18 15.0%
situ, localized, regional, distant), histology (carcinoma, sarcoma, Distant 10 8.3%
fibroepithelial), and hormone status (ER positive/negative, PR posi-
tive/negative). Because of the small cohort size and in order to make
Grade II; Moderately differentiated 20 28.2%
valid comparisons, tumor grade was recoded into low grade (well/mod- Grade III; Poorly differentiated 24 33.8%
erately differentiated) and high grade (poorly differentiated/undiffer- Grade IV; Undifferentiated, anaplastic 9 12.7%
entiated); stage was recoded into early stage (in situ/localized) and Tumor Histology (N = 132)
advanced stage (regional/distant). Historically, adenocarcinomas/sarco-