Larger Tumours at Presentation in Triple-Negative Breast Carcinoma of Young Women: A Single-Centre Pathological Analysis

Background: Triple-negative breast cancer (TNBC) is usually regarded as a disease of younger women, but its frequency and presentation at the two age extremes are rarely compared directly in Indian tertiary-care practice. Material and Methods: We retrospectively analysed 45 women with invasive breast carcinoma on mastectomy or breast-conserving surgery specimens with axillary dissection, diagnosed over 12 months at a single centre: 19 younger than 40 years and 26 aged 60 years or above. TNBC was defined as ER-negative, PR-negative and HER2-negative (HER2 1+ and 2+ counted as negative). Tumour size, nodal status, Nottingham grade, Ki-67 and the Nottingham Prognostic Index (NPI) were compared using Fisher’s exact and Mann–Whitney U tests, with Hodges–Lehmann shift and confidence intervals as effect sizes. Results: TNBC occurred in 10/19 young (52.6%) and 12/26 older women (46.2%) (p = 0.77). Among TNBC cases, young women had much larger tumours (median 6.5 cm, IQR 4.6–9.3, versus 3.0 cm, IQR 2.9–3.6; p = 0.0003; Hodges–Lehmann difference 3.0 cm, 95% CI 1.3–7.0), and 6/10 exceeded 5 cm compared with 0/12 older women (p = 0.003). Nodal positivity (60.0% vs 41.7%), grade 3 (40.0% vs 33.3%) and Ki-67 ≥20% (40.0% vs 33.3%) did not differ significantly. Median NPI was higher in young women (5.1 vs 4.6; p = 0.048), largely reflecting tumour size. The size difference persisted after excluding HER2 2+ cases (p = 0.001). Conclusion: In this small series, TNBC was equally frequent in young and elderly women, but young women presented with substantially larger primary tumours, without a clear difference in grade, proliferation or nodal burden. Earlier detection in women under 40 may matter more than any age-specific biology. Larger multicentre studies are needed.

Keywords: Triple-negative breast neoplasms, young adult, aged, tumour size, Nottingham Prognostic Index, lymph node metastasis, India.