Early-onset breast cancer in two Brazilian tertiary cancer centers: a real-world study of years of life lost and clinical outcomes
- 1Department of Oncology, Hospital Israelita Albert Einstein
- 2Center for Precision Medicine, Hospital Israelita Albert Einstein
Abstract
Introduction: Early-onset breast cancer (EOBC) represents a growing global concern, particularly in low- and middle-income countries, where epidemiological data remain scarce. We evaluated the clinical characteristics, temporal trends, and disease burden of EOBC in two tertiary cancer centers in São Paulo, Brazil, with a focus on Years of Life Lost (YLL) and Disability-Adjusted Life Years (DALY).
Methods: We conducted a retrospective study of patients diagnosed with malignant breast neoplasms between 2018 and 2023 at two tertiary cancer centers in São Paulo, Brazil. EOBC was defined as diagnosis in adult patients (aged ≥18 years) younger than 50 years. Demographics, clinical stage, and germline testing rates were compared between younger (<50) and older (≥50) patients. YLLs were calculated using individualized life expectancy estimates, and DALYs were computed as YLL + Years Lived with Disability (YLD). Group comparisons used chi-squared and Wilcoxon rank-sum tests, and multivariable logistic regression was used to evaluate factors associated with YLL >0.
Results: Among 3,102 patients, 43.5% were aged <50 years. EOBC patients had lower median BMI (24.6 vs. 26.1 kg/m²; p<0.001) and higher germline testing rates (21.3% vs. 11%; p<0.001). Between 2018 and 2023, the proportion of breast cancer diagnoses among patients aged <50 years varied over time, but no statistically significant temporal trend was identified (p=0.30). The distribution of non-metastatic (stages I–III) versus metastatic (stage IV) disease was similar between age groups (p=0.14). Among patients who died during follow-up, median YLL was twice as high among patients aged <50 years compared with those aged ≥50 years (42 vs. 21 years). DALY rates per 1,000 patients were 33% higher among younger patients (3,340.8 vs. 2,509.3), primarily driven by a higher rate of YLL. In multivariable analysis, treatment at the participating public institution remained associated with higher odds of YLL >0 (adjusted OR 2.15; 95% CI 1.18–3.94; p=0.013).
Conclusion: Within two tertiary cancer centers in São Paulo, Brazil, the proportion of EOBC diagnoses varied over the study period, without a statistically significant temporal trend. Patients aged <50 years had a greater aggregate burden of premature mortality, reflected by higher YLL and DALY rates, primarily due to the greater number of potential life years lost when death occurs at younger ages, despite a similar distribution of non-metastatic versus metastatic disease at diagnosis. These findings support the need for further research and may help inform age-specific strategies for the care of younger patients with breast cancer.
Related
- Survival implications of non-organized breast cancer screening in a Brazilian tertiary women’s health center: a retrospective cohort study of 1517 patients
- Clinical and Therapeutic Profile of Dravet Syndrome in Patients Followed at a Brazilian Pediatric Referral Center: Real-World Data from a Tertiary Service
- Effects of rectal retractor use on dosimetric parameters, treatment-related adverse events, and clinical outcomes of cervical cancer brachytherapy: A retrospective tertiary-centre study
- Clinical profile, risk factors and in-hospital outcomes of ST-segment elevation myocardial infarction in young versus older adults: a 5-year retrospective cohort study at a tertiary care centre in Riyadh, Saudi Arabia.
- Multi-omics of tertiary lymphoid structures in breast cancer: clinical significance and biomarker potential
BibTeX
@article{miranda2026earlyonset,
title = {{Early-onset breast cancer in two Brazilian tertiary cancer centers: a real-world study of years of life lost and clinical outcomes}},
author = {Diego Lopes Paim Miranda and Douglas Dias e Silva and Beatriz Viesser Miyamura and Mariana de Moura de Souza and Maria Fernanda Teixeira and Uelson Donizeti Rocioli Junior and Fernando Moura and Pedro Luiz Serrano Uson Junior and Patricia Taranto and Janaina Pontes Batista and Max Senna Mano and Rafael Aliosha Kaliks Guendelmann and Heloisa Veasey Rodrigues and Juliana Rodrigues Beal},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1837330},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1837330/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early-onset breast cancer in two Brazilian tertiary cancer centers: a real-world study of years of life lost and clinical outcomes
AU - Diego Lopes Paim Miranda
AU - Douglas Dias e Silva
AU - Beatriz Viesser Miyamura
AU - Mariana de Moura de Souza
AU - Maria Fernanda Teixeira
AU - Uelson Donizeti Rocioli Junior
AU - Fernando Moura
AU - Pedro Luiz Serrano Uson Junior
AU - Patricia Taranto
AU - Janaina Pontes Batista
AU - Max Senna Mano
AU - Rafael Aliosha Kaliks Guendelmann
AU - Heloisa Veasey Rodrigues
AU - Juliana Rodrigues Beal
PY - 2026
DA - 2026/10/27
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1837330
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1837330/full
AB - Introduction: Early-onset breast cancer (EOBC) represents a growing global concern, particularly in low- and middle-income countries, where epidemiological data remain scarce. We evaluated the clinical characteristics, temporal trends, and disease burden of EOBC in two tertiary cancer centers in São Paulo, Brazil, with a focus on Years of Life Lost (YLL) and Disability-Adjusted Life Years (DALY). Methods: We conducted a retrospective study of patients diagnosed with malignant breast neoplasms between 2018 and 2023 at two tertiary cancer centers in São Paulo, Brazil. EOBC was defined as diagnosis in adult patients (aged ≥18 years) younger than 50 years. Demographics, clinical stage, and germline testing rates were compared between younger (<50) and older (≥50) patients. YLLs were calculated using individualized life expectancy estimates, and DALYs were computed as YLL + Years Lived with Disability (YLD). Group comparisons used chi-squared and Wilcoxon rank-sum tests, and multivariable logistic regression was used to evaluate factors associated with YLL >0. Results: Among 3,102 patients, 43.5% were aged <50 years. EOBC patients had lower median BMI (24.6 vs. 26.1 kg/m²; p<0.001) and higher germline testing rates (21.3% vs. 11%; p<0.001). Between 2018 and 2023, the proportion of breast cancer diagnoses among patients aged <50 years varied over time, but no statistically significant temporal trend was identified (p=0.30). The distribution of non-metastatic (stages I–III) versus metastatic (stage IV) disease was similar between age groups (p=0.14). Among patients who died during follow-up, median YLL was twice as high among patients aged <50 years compared with those aged ≥50 years (42 vs. 21 years). DALY rates per 1,000 patients were 33% higher among younger patients (3,340.8 vs. 2,509.3), primarily driven by a higher rate of YLL. In multivariable analysis, treatment at the participating public institution remained associated with higher odds of YLL >0 (adjusted OR 2.15; 95% CI 1.18–3.94; p=0.013). Conclusion: Within two tertiary cancer centers in São Paulo, Brazil, the proportion of EOBC diagnoses varied over the study period, without a statistically significant temporal trend. Patients aged <50 years had a greater aggregate burden of premature mortality, reflected by higher YLL and DALY rates, primarily due to the greater number of potential life years lost when death occurs at younger ages, despite a similar distribution of non-metastatic versus metastatic disease at diagnosis. These findings support the need for further research and may help inform age-specific strategies for the care of younger patients with breast cancer.
SN - 2234-943X
ER -