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Functional Impact of Breast Cancer by Age at Diagnosis

From the Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School; Department of Medical Oncology, Dana Farber Cancer Institute; and Department of Health and Social Behavior and Department of Epidemiology, Harvard School of Public Health, Boston, MA

Address reprint requests to Candyce Kroenke, Channing Laboratory, 181 Longwood Ave, 3rd floor, Boston, MA 02115; e-mail: candyce.kroenke{at}channing.harvard.edu

PURPOSE: To explore changes in physical and psychosocial function before and after breast cancer by age at diagnosis.

PATIENTS AND METHODS: A total of 122,969 women from the Nurses' Health Study (NHS) and NHS 2, ages 29 to 71 years, who responded to pre- and postfunctional status assessments were included; 1,082 women were diagnosed with breast cancer between 1992 and 1997. Functional status was measured using the Medical Outcomes Study Short Form 36 (SF-36). Mean change in health-related quality of life (HRQoL) scores was computed across categories representing the combination of incident breast cancer (yes or no) and age at diagnosis ( 40, 41 to 64, or 65+ years).

RESULTS: Compared with women 40 years without breast cancer, women with breast cancer experienced significant functional declines. Young (age 40) women who developed breast cancer experienced the largest relative declines in HRQoL (as compared with middle-aged and elderly women) in multiple domains including physical roles (–18.8 v –11.5 and –7.5 points, respectively), bodily pain (–9.0 v –2.7 and –2.7 points), social functioning (–11.3 v –4.3 and –4.4 points) and mental health (–3.1 v 0.0 and +0.4 points). Much of the decline in HRQoL among elderly (age 65) women with breast cancer was age related.

CONCLUSION: Young women may fare worse than middle-aged or elderly women in both physical and psychosocial dimensions after breast cancer diagnosis. The needs of women facing breast cancer may be better understood within a life stage framework.

Supported by grants AG14742, CA87969, and CA50385 from the National Institutes of Health.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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