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The prospective nature of our study eliminates the potential for survival bias, particularly among patients diagnosed with more aggressive histologic subtypes, such as diffuse large B-cell lymphoma [17].
In our study, we found at a more advanced stage and have more aggressive histologic and molecular characteristics, irrespective of the cut-off age at 35y or 40y.
These abnormalities, alone or in combination, may contribute to the earlier onset, advanced stage, more aggressive histologic features, and worse survival of the breast cancers.
African American women have an increased incidence of high grade tumors, which are commonly associated with high proliferative rates (see below, section on more aggressive histologic characteristics).
Our study has shown that young breast cancer patients are found at a more advanced stage and have more aggressive histologic and molecular characteristics, irrespective of the cut-off age at 35y or 40y.
African American women with breast cancer have a worse outcome than Caucasian women according to four breast cancer characteristics: earlier age of onset, more advanced stage, more aggressive histologic features, and worse survival.
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There is thus a range of biological abnormalities in the breast cancer of African American women that could contribute to mitotic defects, aneuploidy, an increase in histologic grade or dedifferentiation, increased nuclear grade, pleomorphism, and central necrosis, all characteristics of histologically more aggressive tumors observed in African American breast cancer.
Although positive immune reactivity to APC7 was observed in more than 60% of breast carcinomas, negative APC7 expression was frequently observed in breast carcinomas with more aggressive characteristics (i.e. a higher histologic grade, a higher nuclear grade, a higher proliferation rate, or aneuploidy).
Basal-like and ERBB2+ subtypes were more aggressive tumors than luminal A and B ones, as indicated by their histologic and Ki-67 grades (P < 0.01), but the basal-like subtype showed less nodal involvement when compared with other subtypes (P < 0.01).
As we did not perform histologic studies of the lymphatics, we cannot add new information whether large tumours are more aggressive in destroying lymphatic vessels on their rim than are small tumours.
Generally, the grade of a tumor follows the histologic grading but a higher surgical grade may be assigned to a tumor if it displays evidence of more aggressive radiographic features or clinical behavior [ 10].
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