Five-year survival prognosis of young, middle-aged, and elderly adult female invasive breast cancer patients by clinical and lifestyle characteristics.

PURPOSE: Early-onset breast cancer incidence has been increasing globally and in Taiwan. However, previous studies have not comprehensively examined how clinical and lifestyle characteristics influence the 5-year survival of breast cancer diagnosed at different stages of adulthood. METHODS: We analyzed the Taiwan National Cancer Registry and Cause of Death datasets to understand how clinical factors (including tumor and treatment characteristics) and lifestyle factors (including body mass index, cigarette smoking, and alcohol consumption) were associated with the 5-year survival of 8471 young, 57,695 middle-aged, and 14,074 elderly female adult invasive breast cancer patients respectively diagnosed at age 20-39, 40-64, and ≥ 65 years between 2002 and 2015, with mortality follow-up to 2020. Poisson regression was used for obtaining the crude and adjusted 5-year survival risk ratios. RESULTS: Clinical and lifestyle characteristics were distributed differently but had mostly similar direction of association with 5-year survival for the three age groups. Receiving any treatment was associated with better survival, especially for elderly patients. Being underweight at initial cancer treatment was associated with worse survival than having normal weight, especially for elderly patients. Current smokers had worse survival than never smokers for middle-aged and elderly patients. The 5-year breast cancer-specific survival was not significantly higher for those of age 45-49 years than 40-44 years, despite the recommended starting screening age is 45 years in Taiwan. CONCLUSION: Our findings contribute to the understanding of early-onset and later-onset female breast cancer characteristics and prognosis, which may inform surveillance and treatment strategies to achieve better breast cancer prognosis.

Trapdoor Deformity Correction Post Nasal Bilobed Flaps for Basal Cell Carcinoma Reconstruction With Multiple Laser Modalities.

ABSTRACT: In case of excision of nasal basal cell carcinoma (BCC), bilobed flaps are considered the criterion standard of reconstruction for defect less than 15 mm in size. However, there is still a risk of trapdoor deformity formation, of which its treatment is less discussed. A 44-year-old woman who was diagnosed with nasal BCC and underwent tumor excision with bilobed flap reconstruction presented with trapdoor deformity postoperatively. The computed Vancouver Scar Scale was 7. After early intervention of multiple laser modalities, including 2 sessions of 585-nm pulsed dye laser with a fluence of 9 J/cm2, pulse duration of 6 milliseconds, and spot size of 6 mm, 2940-nm Er-yttrium aluminum garnet (YAG) laser with a pulse energy of 800-900 mJ, repetition rate of 8-9 Hz, and laser spot size of 3-7 mm, and 5 sessions of 1064-nm Nd:YAG fractional picosecond laser with a pulse energy of 2.30-2.70 mJ, repetition rate of 8 Hz, and laser spot size of 6 mm from 5 to 23 weeks postoperatively, the Vancouver Scar Scale score improved to 1, with significant reduction of trapdoor scar erythema and puffiness. Although BCC is often curable, tumor excision causes unsatisfactory appearance satisfaction problem, owing to the apparent location of the lesion. Factors, such as sebaceous tissue thickness, reconstruction over multiple aesthetic subunits of nose, and damage to nasal cartilage framework structure during tumor removal, may increase the risk of trapdoor formation. Early intervention with multiple laser treatment can significantly revise the deformity.

Five-year Survival Trends for Young Adult Cancers Diagnosed from 2002 to 2014 in Taiwan and the United States.

BACKGROUND: Young adult cancer incidence has been increasing in Taiwan, but no studies have examined their survival trends. METHODS: We analyzed data from the Taiwan National Health Insurance Research Database and the U.S. Surveillance, Epidemiology, and End Results Program. We obtained the five-year survival estimates and trends for primary invasive cancers diagnosed at 20-39 years of age from 2002 to 2014. When analyzing specific cancers, we focused on the common young adult cancers in Taiwan. For the trend analysis, the average annual percent change (AAPC) was calculated using joinpoint Regression Program. We also obtained estimates stratified by sex or age at cancer diagnosis. RESULTS: The five-year age-standardized relative survival for all young adult cancers combined significantly increased in Taiwan [AAPC = 1.4%; 95% confidence interval (CI), 1.3%-1.5%] and the United States (AAPC = 0.4%; 95% CI, 0.3%-0.6%). Cancers occurring in both sexes had similar trend directions for both sexes. Lung and bronchus cancer, liver cancer, and leukemia had the most survival improvement in both regions. However, the five-year relative survival for cervical cancer declined in Taiwan (AAPC = -0.6%; 95% CI, -1.0% to -0.1%) and did not improve in the United States (AAPC = -0.1%; 95% CI, -0.4%-0.2%). CONCLUSIONS: Survival has improved for most but not all of the common young adult cancer types in Taiwan. Additional studies can understand why survival has not improved for certain cancer types, and examine subtype-specific survival trends. IMPACT: This is the first study of five-year survival trends for young adult cancers in Taiwan and the United States stratified by sex or age at diagnosis.