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Breast cancer at a young age is associated with poor prognosis. The Prospective Study of Outcomes in Sporadic and Hereditary Breast Cancer (POSH) was designed to investigate factors affecting prognosis in this patient group.Between 2000 and 2008, 2956 patients aged 40 years or younger were recruited to a UK multicenter prospective observational cohort study (POSH). Details of tumor pathology, disease stage, treatment received, and outcome were recorded. Overall survival (OS) and distant disease-free interval (DDFI) were assessed using Kaplan-Meier curves. All statistical tests were two-sided.Median age of patients was 36 years. Median tumor diameter was 22 mm, and 50% of patients had positive lymph nodes; 59% of tumors were grade 3, 33.7% were estrogen receptor (ER) negative, and 24% were human epidermal growth factor receptor 2 (HER2) positive. Five-year OS was higher for patients with ER-positive than ER-negative tumors (85.0%, 95% confidence interval [CI] = 83.2% to 86.7% vs 75.7%, 95% CI = 72.8% to 78.4%; P < .001), but by eight years, survival was almost equal. The eight-year OS of patients with ER-positive tumors was similar to that of patients with ER-negative tumors in both HER2-positive and HER2-negative subgroups. The flexible parametric survival model for OS shows that the risk of death increases steadily over time for patients with ER-positive tumors in contrast to patients with ER-negative tumors, where risk of death peaked at two years.These results confirm the increased frequency of ER-negative tumors and early relapse in young patients and also demonstrate the equally poor longer-term outlook of young patients who have ER-positive tumors with HER2-negative or -positive disease.

Original publication




Journal article


Journal of the National Cancer Institute

Publication Date





978 - 988


Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.


POSH Study Steering Group, Lymph Nodes, Humans, Carcinoma, Breast Neoplasms, Lymphatic Metastasis, Neoplasm Recurrence, Local, Tamoxifen, Receptor, erbB-2, Receptors, Estrogen, Antineoplastic Combined Chemotherapy Protocols, Neoplasm Staging, Prognosis, Disease-Free Survival, Treatment Outcome, Chemotherapy, Adjuvant, Neoadjuvant Therapy, Cohort Studies, Prospective Studies, Predictive Value of Tests, Age Factors, Adult, Female, Kaplan-Meier Estimate, Antibodies, Monoclonal, Humanized, Biomarkers, Tumor, Trastuzumab, United Kingdom