Prognosis of Breast Cancer Occurring in Patients below the Age of 35 Years Compared with Groups above the Age of 36 Years

PURPOSE: The peak age for breast cancer in Korea is in the fifth decade, which is younger than that of Western countries. However, controversy exists about the effect of age on the prognosis. The purpose of this study was to investigate the impact of age on the prognosis in young breast cancer patients. METHODS: Nine hundred and seventeen patients, having undergone a breast cancer operation at our hospital, between January 1990 and December 2001, were included. The patients were divided into two groups: young age (under 35 years) and old age (> 35 years) groups. The factors analyzed included the tumor size, number of lymph node metastasis, stage, hormonal receptor status, c-erbB-2 status, p53 status, operation method and adjuvant therapy. These factors and the survival rates were compared between the two groups using SPSS 12.0. RESULTS: One hundred and twenty three (13.4%) and 794 (86.6%) patients were younger than and older than 35 years, respectively. There were no statistical differences in the clinicopathological factors between the two groups, with the exception of stage. The 5 year disease free survival rates in the young and old age groups were 67.0 and 77.5%, respectively (P=0.027). When adjusted for stage, the rates for the old and young age groups in stage I were 90.7 and 72.4%, respectively. Also, for stages II and III, those in the young age group had worse prognosis compared to those in the old age group. The 5 year overall survival was lower in the young age group, but with no statistical significance (P=0.108). CONCLUSION: The young aged breast cancer patients had a worse prognosis than the old age group. Therefore, aggressive adjuvant treatment should be considered to reduce the recurrence in young patient, despite the earlier occurrence of breast cancer.

Clinical Manifestations and Microbiological Features Correlating with Central Venous Catheter Related Infection

PURPOSE: Central venous catheterization is widely used to supply substantial amounts of fluids, total parenteral nutrition and hemodialysis in renal failure patients, as well as for measuring the central venous pressure. The most common complications encountered during central venous catheterization include catheter-related infections and subsequent sepsis. Therefore, when fever exists in patients with a central venous catheter, an immediate blood culture should be performed, and if the fever persists, an infection must be suspected and the catheter immediately removed; a culture of the catheter tip should also be performed. To date, no definite clinical details relating to this matter have been reported. METHODS: Between December 2002 and March 2005, a retrospective study was undertaken using the medical records of 85 patients. In those patients where a fever lasted for more than 8 hours, or when catheterization was no longer needed, the catheter tip cultures were sent to the microbiology laboratory. Blood cultures were also performed on 49 patients with a fever. The Chi-square method using the PC SPSS program, with P value less than 0.05 as statically significant. RESULTS: Of the 85 patients where the catheters were removed, significant microorganisms were detected 20 of the 49 with a fever. Only 5 of the remaining 36 patients had their catheters spontaneously removed. Moreover, 14 of the 20 patients with significant microorganisms were found to have kept their catheter in place for more than 14 days. Of the 49 patients with a fever, in who blood cultures were undertaken, 13 showed specific microorganisms, with 6 of these showing the same results for both their blood and catheter tip cultures, which enabled the definite diagnosis of the catheter-related infection and underlying sepsis. Various microorganisms were detected from the catheter tip cultures, including Staphylococcus species the CNS, with S. aureus being the most common, at 61.6%. CONCLUSION: A central venous catheter should be removed immediately when an infection is suspected, but early broad-spectrum antibiotics therapy should be commenced due to the time required to obtain the culture results. Moreover, even if a fever does not exist in patients with a catheter inserted for more than 14 days, infection and sepsis from the catheter should be of concern, with a more cautious approach being mandatory.