After Early-Stage Breast Cancer, Risk of Metastatic Recurrence Higher for Younger People
People ages 21 to 35 diagnosed with early-stage breast cancer that is estrogen receptor-positive and HER2-negative were nearly four times more likely to have the cancer come back (recur) in a part of the body away from the breast five to 10 years after surgery than people ages 41 to 45. When breast cancer comes back away from the breast in this time frame, doctors call it late, distant recurrence.
The study was published online in JAMA Network Open.
Key takeaways
11% of people ages 21 to 35 had a late, distant recurrence, compared to 6% of people aged 36 to 40 and 3% of people ages 41 to 45.
Although distant recurrence rates were higher among people ages 21 to 35, they had similar overall survival rates as those in the 36 to 40 and 41 to 45 age groups.
Overall survival rates were between 97% and 99% for all three age groups.
What the results mean for you
The results of this study highlight the importance of long-term monitoring and follow-up care for young people diagnosed with breast cancer — particularly those diagnosed before age 35 with estrogen receptor-positive, HER2-negative breast cancer. In the study, being younger didn’t seem to negatively impact overall survival rates: Overall survival rates were between 97% and 99% for all three age groups.
The health care providers and resources that might be most helpful to you during follow-up care may be different from those you used during breast cancer treatment. These 10 tips can help you get the comprehensive care that best meets your needs.
Why do the study?
Research shows that younger people diagnosed with estrogen receptor-positive, HER2-negative breast cancer have a poorer prognosis than older people. The scientists did this study to determine if age was linked to the risk of late, distant recurrence for this type of breast cancer.
About the study
The study included 2,772 people diagnosed with estrogen receptor-positive, HER2-negative breast cancer:
13.3% were ages 21 to 35
31.9% were ages 36 to 45
54.7% were ages 41 to 45
All the people had breast cancer surgery between January 2000 and December 2011. After surgery, about 76% of the people received chemotherapy and about 72% received radiation therapy. They all took hormonal therapy (97.5% took tamoxifen):
90% took hormonal therapy for five or more years after surgery
10% took hormonal therapy for two to five years after surgery
Half the people were followed for less than 11 years after surgery and half were followed for longer periods of time. All the people in the study were followed for at least five years.
Detailed results
Compared to older people, younger people were more likely to have a higher grade breast cancer:
28.9% of people ages 21 to 35 had a grade 3 tumor
16.8% of people ages 36 to 40 had a grade 3 tumor
18% of people ages 41 to 45 had a grade 3 tumor
Younger people also were more likely to receive chemotherapy and take hormonal therapy for less than five years:
83% of people ages 21 to 35 received chemotherapy, compared to 78.8% of people ages 36 to 40 and 73.2% of people ages 41 to 45
15.9% of people ages 21 to 35 took hormonal therapy for less than five years, compared to 7.9% of people ages 36 to 40 and 7.4% of people ages 41 to 45
Compared to people in the two older age groups, people ages 21 to 35 were more likely to have:
the cancer come back in the same area of the breast or the nearby lymph nodes, called locoregional recurrence
any type of non-metastatic recurrence, meaning the cancer could come back in the same or opposite breast
late, metastatic recurrence
Shin DS, Lee J, Kang E, et al. Age and Late Recurrence in Young Patients With ER–Positive, ERBB2-Negative Breast Cancer. JAMA Netw Open. 2024;7(11):e2442663.
— Last updated on July 1, 2025 at 8:40 PM