Lutte contre les cancers

Qualité de vie, soins de support

A partir d'une enquête auprès de 82 patients atteints d'un cancer de la cavité buccale nouvellement diagnostiqué et traité par radiothérapie ou chimioradiothérapie concomitante, cette étude prospective longitudinale analyse, après le début du traitement et sur une période de 6 mois, l'évolution des symptômes physiques, de l'état fonctionnel et des besoins des patients en soins de support

Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy
• Psycho-Oncology, sous presse, 2012 (résumé)

Détails

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A partir d'une enquête auprès de 82 patients atteints d'un cancer de la cavité buccale nouvellement diagnostiqué et traité par radiothérapie ou chimioradiothérapie concomitante, cette étude prospective longitudinale analyse, après le début du traitement et sur une période de 6 mois, l'évolution des symptômes physiques, de l'état fonctionnel et des besoins des patients en soins de support

“Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy”

• Chen, Shu-Ching;Lai, Yeur-Hur;Liao, Chun-Ta;Chang, Joseph Tung-Chien;Lin, Chien-Yu;Fan, Kang-Hsing;Huang, Bing-Shen

Objective This study aimed to examine changes in physical symptom severity, functional status, supportive care needs, and related factors in oral cavity cancer patients during 6 months after beginning radiation therapy (RT) or concurrent chemotherapy and radiation therapy (CCRT). Methods A prospective longitudinal study was conducted involving oral cavity cancer patients from an RT clinic at a medical center in northern Taiwan. Patients were assessed for supportive care needs and physical symptoms at five time points: before the beginning of RT or CCRT and at 1, 2, 3, and 6 months after beginning RT or CCRT. The generalized estimating equation was used to identify predictors of overall needs as well as six specific dimensions of needs. Results A total of 82 patients completed the 6 months of follow-up. Patients had moderate to high levels of supportive care needs over the 6 months. Although the highest information need was at the pretreatment phase, in general, the peak for ...

Mots clés : Voies aérodigestives supérieures; Lutte contre les cancers (Qualité de vie, soins de support)

Observation

Menée sur 131 jeunes participants en bonne santé et suivis durant 7 ans (âge moyen : 28,9 ans), cette étude finlandaise évalue la prévalence et l'incidence d'une infection orale par le papillomavirus humain en fonction des génotypes viraux

Oral Mucosa as a Reservoir of Human Papillomavirus: Point Prevalence, Genotype Distribution, and Incident Infections Among Males in a 7-year Prospective Study
• European urology, sous presse, 2012 (résumé)

Détails

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Menée sur 131 jeunes participants en bonne santé et suivis durant 7 ans (âge moyen : 28,9 ans), cette étude finlandaise évalue la prévalence et l'incidence d'une infection orale par le papillomavirus humain en fonction des génotypes viraux

“Oral Mucosa as a Reservoir of Human Papillomavirus: Point Prevalence, Genotype Distribution, and Incident Infections Among Males in a 7-year Prospective Study”

• Katja, Kero;Jaana, Rautava;Kari, Syrjänen;Seija, Grenman;Stina, Syrjänen

Background : In addition to the anogenital malignancies, human papillomavirus (HPV) has been linked to oropharyngeal cancer as an important risk factor in both men and women. Knowledge of oral HPV infection among males is needed to elucidate the transmission routes and potential for prevention. Objective : To assess the prevalence, genotype distribution, and incidence of oral HPV infections among healthy Finnish men followed for 7 yr. Design, setting, and participants : Oral scrapings for HPV testing were taken from 131 fathers-to-be (mean age: 28.9 yr) at baseline and at 2-mo, 6-mo, 12-mo, 24-mo, 36-mo, and 7-yr follow-up visits to detect prevalent and incident HPV infections. Purified DNA extracted from scrapings was used for HPV genotyping, with the Multimetrix kit (Progen Biotechnik, Heidelberg, Germany) detecting 24 genotypes. Outcome measurements and statistical analysis Point prevalence, genotype distribution, and incident rates of oral HPV infections. Demographic data were ...

Mots clés : Voies aérodigestives supérieures; Lutte contre les cancers (Observation)

A partir de données administratives portant sur la période 1998-2006 et incluant 149 045 femmes bénéficiant de l'assurance maladie Medicare (âge : 67 ans et plus), cette étude américaine analyse la relation entre la fréquence d'examens par mammographie, la présence de comorbidités et l'incidence du cancer du sein en fonction du stade au diagnostic

Risk of Advanced Stage Breast Cancer Among Older Women with Comorbidities
• Cancer Epidemiology Biomarkers & Prevention, sous presse, 2012 (résumé)

Détails

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A partir de données administratives portant sur la période 1998-2006 et incluant 149 045 femmes bénéficiant de l'assurance maladie Medicare (âge : 67 ans et plus), cette étude américaine analyse la relation entre la fréquence d'examens par mammographie, la présence de comorbidités et l'incidence du cancer du sein en fonction du stade au diagnostic

“Risk of Advanced Stage Breast Cancer Among Older Women with Comorbidities”

• Yasmeen, Shagufta;Hubbard, Rebecca;Romano, Patrick S.;Zhu, Weiwei;Geller, Berta M.;Onega, Tracy;Yankaskas, Bonnie;Miglioretti, Diana L.;Kerlikowske, Karla

Background: Comorbidities have been suggested influencing mammography utilization and breast cancer stage at diagnosis. We compared mammography use, and overall and advanced-stage breast cancer rates, among female Medicare beneficiaries with different levels of comorbidity. Methods: We used linked Breast Cancer Surveillance Consortium (BCSC) and Medicare claims data from 1998 through 2006 to ascertain comorbidities among 149,045 female Medicare beneficiaries age 67 and older who had mammography. We defined comorbidities as either "unstable" (life threatening or difficult to control) or "stable" (age-related with potential to affect daily activity) based on claims within two years before each mammogram. Results: Having undergone two mammograms within 30 months was more common in women with stable comorbidities (86%) than in those with unstable (80.3%) or no (80.9%) comorbidities. Overall rates of advanced-stage breast cancer were lower among women with no comorbidities (0.5 per 1000 ...

Mots clés : Sein; Lutte contre les cancers (Observation)

Menée sur une cohorte de 8 478 femmes atteintes d'un cancer du sein traité entre 1975 et 2006, cette étude monocentrique évalue, selon la latéralité de la tumeur primitive ou le délai de récidive controlatérale métachrone, l'incidence des métastases par type d'organe

Patterns of metastasis in women with metachronous contralateral breast cancer
• British Journal of Cancer, sous presse, 2012 (résumé)

Détails

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Menée sur une cohorte de 8 478 femmes atteintes d'un cancer du sein traité entre 1975 et 2006, cette étude monocentrique évalue, selon la latéralité de la tumeur primitive ou le délai de récidive controlatérale métachrone, l'incidence des métastases par type d'organe

“Patterns of metastasis in women with metachronous contralateral breast cancer”

• Vichapat, V.;Garmo, H.;Holmberg, L.;Fentiman, I. S.;Tutt, A.;Gillett, C.;Luchtenborg, M.

Background :The understanding of metastatic patterns after metachronous contralateral breast cancer (CBC) may help determine the biological nature of CBC. Methods : A cohort of 8478 women with breast cancer treated at Guy’s and St Thomas’ NHS Foundation Trust between 1975 and 2006 were studied. Organ-specific 5-year cumulative incidence and incidence rate ratios were assessed for women diagnosed with unilateral breast cancer (UBC), CBC within 5 years and CBC more than 5 years of the initial diagnosis. Results : Women diagnosed with CBC within 5 years had a higher incidence of metastases in all organs compared with UBC. Women with a short interval time to CBC developed metastasis more rapidly and were more likely to develop visceral and distant cutaneous metastases compared with bone metastasis. Conclusion : These findings explain poor prognosis of women with early occurring CBC and suggest that some of these CBCs are indicators of aggressive and/or systemic disease.

Mots clés : Sein; Lutte contre les cancers (Observation)

A partir de données administratives portant sur 423 patients atteints d'un cancer du poumon, cette étude monocentrique britannique identifie les inégalités de santé en fonction de l'appartenance ethnique des patients et analyse l'impact de ces inégalités sur les facteurs pronostiques, les traitements reçus et la survie globale

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK
• European Journal of Cancer Care, sous presse, 2012 (résumé)

Détails

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A partir de données administratives portant sur 423 patients atteints d'un cancer du poumon, cette étude monocentrique britannique identifie les inégalités de santé en fonction de l'appartenance ethnique des patients et analyse l'impact de ces inégalités sur les facteurs pronostiques, les traitements reçus et la survie globale

“Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK”

• Nimako, K.;Gunapala, R.;Popat, S.;O'Brien, M. E. R.

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK International and UK data suggest that there are ethnic differences in survival for some malignancies. The aim of the present study was to identify any health inequalities related to lung cancer and ethnicity. Data on 423 patients with a diagnosis of lung cancer treated at a large specialist cancer hospital in London UK were analysed. Data on stage of disease at diagnosis, co-morbidities, socio-economic status, treatments received and survival were collected and examined for differences by ethnic group. There was a significant difference between black and minority ethnic (BME) patients and White-European patients in socio-economic status (Chi-square test P-value < 0.001). BME patients were over-represented in the most deprived socio-economic groups and under-represented in the most affluent. There were no significant differences in histology, stage of disease, ...

Mots clés : Poumon; Lutte contre les cancers (Observation)

A partir de données de registres britanniques portant sur des patients âgés de 0 à 49 ans, cette étude analyse, en fonction de la densité de population et du niveau de précarité des zones géographiques, l'incidence d'ostéosarcomes (2 566 cas) ou de sarcomes d'Ewing (1 650 cas) sur la période 1980-2005 et identifie les facteurs de risques associés

Small-area analyses of bone cancer diagnosed in Great Britain provide clues to aetiology
• BMC Cancer, Vol. 12 (1), pp. 270, 2012 (article en libre accès)

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A partir de données de registres britanniques portant sur des patients âgés de 0 à 49 ans, cette étude analyse, en fonction de la densité de population et du niveau de précarité des zones géographiques, l'incidence d'ostéosarcomes (2 566 cas) ou de sarcomes d'Ewing (1 650 cas) sur la période 1980-2005 et identifie les facteurs de risques associés

“Small-area analyses of bone cancer diagnosed in Great Britain provide clues to aetiology”

• McNally, Richard;Blakey, Karen;Parslow, Roger;James, Peter;Gomez Pozo, Basilio;Stiller, Charles;Vincent, Tim;Norman, Paul;McKinney, Patricia;Murphy, Michael;Craft, Alan;Feltbower, Richard

Background : The aetiology of bone cancers is poorly understood. This study examined geographical patterning in incidence of primary bone cancers diagnosed in 0-49 year olds in Great Britain during 1980-2005 to provide information on factors linked with disease development. We investigated putative associations with deprivation and population density. Methods : Data on osteosarcoma and Ewing sarcoma were obtained from national population-based registries. Negative binomial regression was used to examine the relationship between incidence rates and the Townsend deprivation score (and its component variables) and small-area population density. Results : The study analyzed 2566 osteosarcoma and 1650 Ewing sarcoma cases. For females with osteosarcoma, statistically significant decreased risk was associated with higher levels of deprivation (relative risk [RR] per unit increase in deprivation score=0.969; 95 % confidence interval [CI] 0.9460.993). For all Ewing sarcoma combined, ...

Mots clés : Os; Lutte contre les cancers (Observation)

Mené en Allemagne sur 120 patients atteints d'un lymphome du tissu lymphoïde associé à la muqueuse gastrique et ayant reçu un traitement pour éradiquer la bactérie Helicobacter pylori (durée médiane de suivi :10 ans), cet essai prospectif multicentrique évalue, du point de vue de la rémission complète et de la présence de cellules tumorales résiduelles, les résultats cliniques à long terme, puis compare l'incidence d'un second cancer parmi ces patients à celle mesurée dans la population générale

Second Cancers and Residual Disease in Patients Treated for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma by Helicobacter pylori Eradication and Followed for 10 Years
• Gastroenterology, sous presse, 2012 (résumé)

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Mené en Allemagne sur 120 patients atteints d'un lymphome du tissu lymphoïde associé à la muqueuse gastrique et ayant reçu un traitement pour éradiquer la bactérie Helicobacter pylori (durée médiane de suivi :10 ans), cet essai prospectif multicentrique évalue, du point de vue de la rémission complète et de la présence de cellules tumorales résiduelles, les résultats cliniques à long terme, puis compare l'incidence d'un second cancer parmi ces patients à celle mesurée dans la population générale

“Second Cancers and Residual Disease in Patients Treated for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma by Helicobacter pylori Eradication and Followed for 10 Years”

• Wündisch, Thomas;Dieckhoff, Philipp;Greene, Brandon;Thiede, Christian;Wilhelm, Christian;Stolte, Manfred;Neubauer, Andreas

Cure of Helicobacter pylori infection induces remission in most patients with gastric mucosa-associated lymphoid tissue lymphoma (GML) that is associated with these bacteria. We determined the long-term outcomes of these patients a prospective multicenter trial, and investigated whether they developed second cancers or had histologic residual disease. We followed 120 patients with stage EI1 GML for a median of 122 months after H pyorli eradication (range, 1–171 months). Remission was determined by histology analysis and development of second cancers was documented. Of the patients, 80% (96/120) achieved complete remission from GML, with 80% of those (77/96) remained disease free. The estimated mean survival time in the Kaplan-Meier analysis was 147 months (95% confidence interval [CI], 138–156 months). Of the patients that achieved complete remission, 17% (16/96) had histologic residual disease after a median of 32 months (range, 3–68 months). Disease did not progress in any of ...

Mots clés : Estomac; Lutte contre les cancers (Observation)

A partir des données du registre américain du cancer portant sur 69 739 patientes atteintes d'un cancer du col de l'utérus diagnostiqué entre 2000 et 2007 (âge : 21 à 85 ans), cette étude analyse l'association entre l'âge des patientes lors du dépistage, leur affiliation ou non à une assurance maladie publique (Medicaid ou Medicare) ou privée et le stade de la maladie au diagnostic

Association of Insurance Status and Age With Cervical Cancer Stage at Diagnosis: National Cancer Database, 2000–2007
• American Journal of Public Health, sous presse, 2012 (résumé)

Détails

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A partir des données du registre américain du cancer portant sur 69 739 patientes atteintes d'un cancer du col de l'utérus diagnostiqué entre 2000 et 2007 (âge : 21 à 85 ans), cette étude analyse l'association entre l'âge des patientes lors du dépistage, leur affiliation ou non à une assurance maladie publique (Medicaid ou Medicare) ou privée et le stade de la maladie au diagnostic

“Association of Insurance Status and Age With Cervical Cancer Stage at Diagnosis: National Cancer Database, 2000–2007”

• Fedewa, Stacey A.;Cokkinides, Vilma;Virgo, Katherine S.;Bandi, Priti;Saslow, Debbie;Ward, Elizabeth M.

Objectives. We examined the relationship of age at diagnosis and insurance status with stage among cervical cancer patients aged 21 to 85 years. Methods. We selected data on women (n = 69 739) diagnosed with invasive cervical cancer between 2000 and 2007 from the National Cancer Database. We evaluated the association between late stage (stage III/IV) and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors. We used multivariable log binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Results. The proportion of late-stage disease increased with age: from 16.53% (21–34 years) to 42.44% (≥ 70 years). The adjusted relative risk of advanced-stage disease among women aged 50 years and older was 2.2 to 2.5 times that of patients aged 21 to 34 years. Uninsured (RR = 1.44; 95% CI = 1.40, 1.49), Medicaid (RR = 1.37, 95% CI = 1.34, 1.41), younger Medicare (RR = 1.12, 95% CI = 1.06, 1.19), ...

Mots clés : Col de l'utérus; Lutte contre les cancers (Observation)

A partir des données de deux enquêtes nationales américaines incluant au total 19 144 participants, cette étude évalue la prévalence d'une consommation d'alcool excessive ou à risque, à l'âge adulte, chez les frères et sœurs de patients ayant survécu à un cancer pédiatrique (3034 cas et 10 398 témoins)

Prevalence and predictors of risky and heavy alcohol consumption among adult siblings of childhood cancer survivors
• Psycho-Oncology, sous presse, 2012 (résumé)

Détails

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A partir des données de deux enquêtes nationales américaines incluant au total 19 144 participants, cette étude évalue la prévalence d'une consommation d'alcool excessive ou à risque, à l'âge adulte, chez les frères et sœurs de patients ayant survécu à un cancer pédiatrique (3034 cas et 10 398 témoins)

“Prevalence and predictors of risky and heavy alcohol consumption among adult siblings of childhood cancer survivors”

• Lown, E. Anne;Mertens, Ann C.;Korcha, Rachael A.;Leisenring, Wendy;Hudson, Melissa M.;Greenfield, Thomas K.;Robison, Leslie L.;Zeltzer, Lonnie K.

Objective To describe alcohol consumption patterns and risk factors for risky and heavy alcohol use among siblings of childhood cancer survivors compared with survivors and national controls. Methods Secondary analysis of prospectively collected data from two national surveys was performed including a cohort of 3034 adult siblings of childhood cancer survivors (age 18–56 years) and 10,398 adult childhood cancer survivors, both from the Childhood Cancer Survivor Study, plus 5712 adult participants from the population-based National Alcohol Survey. Cancer-related experiences, self-reported current health, and mental health were examined in relation to alcohol consumption patterns including heavy and risky drinking. Results Adult siblings of childhood cancer survivors were more likely to be heavy drinkers (ORadj = 1.3; 1.0–1.6) and risky drinkers (ORadj = 1.3; 1.1–1.6) compared with controls from a national sample. Siblings were also more likely to drink at these two levels ...

Mots clés : Cancer (général); Lutte contre les cancers (Observation)

Approches psycho-sociales

A partir d'une enquête menée auprès de 371 membres de familles ayant deux parents ou plus atteints d'un cancer du pancréas et auprès de 1 528 témoins, cette étude analyse leurs inquiétudes par rapport au risque de développer la maladie et évalue leurs comportements vis-à-vis des différents tests et examens de détection précoce

Factors influencing receptivity to future screening options for pancreatic cancer in those with and without pancreatic cancer family history
• Hereditary Cancer in Clinical Practice, Vol. 10 (1), pp. 8, 2012 (résumé)

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A partir d'une enquête menée auprès de 371 membres de familles ayant deux parents ou plus atteints d'un cancer du pancréas et auprès de 1 528 témoins, cette étude analyse leurs inquiétudes par rapport au risque de développer la maladie et évalue leurs comportements vis-à-vis des différents tests et examens de détection précoce

“Factors influencing receptivity to future screening options for pancreatic cancer in those with and without pancreatic cancer family history”

• Radecki Breitkopf, Carmen;Sinicrope, Pamela;Rabe, Kari;Brockman, Tabetha;Patten, Christi;McWilliams, Robert;Ehlers, Shawna;Petersen, Gloria

BACKGROUND:Pancreatic cancer (PC) is considered the most lethal cancer and approximately 10% of PC is hereditary. The purpose of the study was to assess attitudes of at-risk family members with two or more relatives affected with pancreas cancer (PC) toward PC risk and future screening options.METHODS:At-risk family members and primary care controls were surveyed regarding perceived PC risk, PC worry/concern, attitude toward cancer screening, screening test accuracy, and intentions regarding PC screening via blood testing or more invasive endoscopic ultrasound (EUS).RESULTS:PC family members reported greater perceived risk of PC than controls (54% vs. 6%, respectively, p < 0.0001). PC family members also reported higher levels of PC worry/concern than controls (p < 0.0001), although 19% of PC family members indicated they were "not at all concerned" about getting PC. PC family members indicated greater acceptance of a false-negative result on a PC screening test relative to controls ...

Mots clés : Pancréas; Lutte contre les cancers (Approches psycho-sociales)

Menée aux Etats-Unis, cette étude évalue les propriétés psychométriques d'un outil comportant 36 items et destiné à mesurer la détresse psychologique des patients ayant survécu à un cancer (319 cas)

Demonstrating the psychometric properties of a problem-related distress screener in a community sample of 319 cancer survivors
• Psycho-Oncology, sous presse, 2012 (résumé)

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Menée aux Etats-Unis, cette étude évalue les propriétés psychométriques d'un outil comportant 36 items et destiné à mesurer la détresse psychologique des patients ayant survécu à un cancer (319 cas)

“Demonstrating the psychometric properties of a problem-related distress screener in a community sample of 319 cancer survivors”

• Miller, Melissa F.;Buzaglo, Joanne S.;Clark, Karen L.;Loscalzo, Matthew J.;Kennedy, Victoria;Taylor, Julie;Dougherty, Kasey Ryan;Golant, Mitch

Objective The purpose was to test the psychometric properties of a 36-item community-based problem-related distress screening tool, among 319 cancer survivors recruited across 14 affiliates of the Cancer Support Community. Methods Internal reliability was estimated using Cronbach's alpha coefficient. Test–retest reliability was assessed using the intra-class correlation coefficient (ICC). Concurrent validity was determined by correlations with the Functional Assessment of Cancer Therapy-General Well-Being Scale (FACT-G), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Distress Thermometer (DT) and receiver operating characteristic (ROC) curve analysis using the CES-D (≥16) and DT (≥4) as the criterion. Non-parametric analysis of variance was used to establish discriminant validity. Results The distress screener demonstrated high internal consistency (Cronbach's alpha = 0.91) and strong test–retest reliability (ICC ≥ 0.75). Summary scores of the ...

Mots clés : Cancer (général); Lutte contre les cancers (Approches psycho-sociales)

Sensibilisation et communication

Menée auprès de128 jeunes fumeurs, cette étude américaine identifie les raisons pour lesquelles ils pourraient accepter de se soumettre à un test génétique évaluant leur risque de cancer du poumon et analyse la relation entre leurs motivations et leurs intentions réelles

Motivations for genetic testing for lung cancer risk among young smokers
• Tobacco Control, sous presse, 2012 (résumé)

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Menée auprès de128 jeunes fumeurs, cette étude américaine identifie les raisons pour lesquelles ils pourraient accepter de se soumettre à un test génétique évaluant leur risque de cancer du poumon et analyse la relation entre leurs motivations et leurs intentions réelles

“Motivations for genetic testing for lung cancer risk among young smokers”

• O'Neill, Suzanne C;Lipkus, Isaac M;Sanderson, Saskia C;Shepperd, James;Docherty, Sharron;McBride, Colleen M

Objective To examine why young people might want to undergo genetic susceptibility testing for lung cancer despite knowing that tested gene variants are associated with small increases in disease risk. Methods The authors used a mixed-method approach to evaluate motives for and against genetic testing and the association between these motivations and testing intentions in 128 college students who smoke.Results Exploratory factor analysis yielded four reliable factors: Test Scepticism, Test Optimism, Knowledge Enhancement and Smoking Optimism. Test Optimism and Knowledge Enhancement correlated positively with intentions to test in bivariate and multivariate analyses (ps<0.001). Test Scepticism correlated negatively with testing intentions in multivariate analyses (p<0.05). Open-ended questions assessing testing motivations generally replicated themes of the quantitative survey.Conclusion In addition to learning about health risks, young people may be motivated to seek genetic testing ...

Mots clés : Poumon; Lutte contre les cancers (Sensibilisation et communication)

Ressources et infrastructures (Lutte contre les cancers)

Cet article fait le point sur les connaissances relatives au cancer du sein chez les femmes de moins de 40 ans, notamment sur les facteurs de risque, les caractéristiques tumorales et les facteurs prédictifs associés à la maladie

Breast cancer in young women
• Nature Reviews Clinical Oncology, sous presse, 2012 (résumé)

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Cet article fait le point sur les connaissances relatives au cancer du sein chez les femmes de moins de 40 ans, notamment sur les facteurs de risque, les caractéristiques tumorales et les facteurs prédictifs associés à la maladie

“Breast cancer in young women”

• Narod, Steven A.

About one in 300 women will be diagnosed with breast cancer before the age of 40. Advances in screening have not had an impact on mortality in women who are too young to be candidates for screening. Risk factors for early breast cancer include a lean body habitus and recent use of an oral contraceptive. Breast cancers in very young women are typically aggressive, in part owing to the over-representation of high-grade, triple-negative tumours, but young age is an independent negative predictor of cancer-specific survival. Very early age-of-onset also correlates strongly with the risk of local recurrence and with the odds of contralateral breast cancer. Given the high risks of local and distant recurrence in young women with invasive breast cancer, most (if not all) young patients are candidates for chemotherapy. It is hoped that by increasing breast cancer awareness, the proportion of invasive breast cancers that are diagnosed at 2.0 cm or smaller will increase and that this will lead ...