Prevalence and risk of anemia and iron deficiency anemia in premenopausal women with breast cancer: A single-center retrospective study.

Abstract

e24166 Background: Anemia is common in breast cancer patients at diagnosis and during treatment. It has been associated with reduced treatment response, decreased quality of life, and inferior survival outcomes. Iron deficiency anemia (IDA) is a particularly important contributor, especially in premenopausal women. Although studies from Malaysia and Saudi Arabia identified premenopausal status as a risk factor for IDA in breast cancer patients, data from developed countries, including the United States, remain limited. We conducted a single-center retrospective cohort study to measure the prevalence, incidence and risk factors for IDA in premenopausal women with breast cancer. Methods: We performed a retrospective chart review of premenopausal female breast cancer patients age ≤55 years who received care at Stony Brook University Hospital between 2005–2025. Demographic, clinical, and laboratory data were extracted. Baseline anemia prevalence, treatment-related anemia incidence, and iron deficiency anemia rates were determined. IDA was defined as hemoglobin < 12 g/dL with either ferritin < 30 ng/mL, or ferritin 30-100 ng/mL with transferrin saturation (Tsat) < 20%. Results: A total of 281 patients were included. Median age was 44 years (range, 23–55). Caucasian (74%) and African American (7.1%) were the most common races, and 51 patients (23%) were Hispanic. A total of 162 patients (57.7%) received chemotherapy, 269 (95.8%) received surgery, and 237 (84.3%) received endocrine therapy. At time of cancer diagnosis, 18.1% (51/281) of patients had anemia based on the above pre-defined parameters. During treatment, 59.6% (137/230) developed treatment-related anemia. Fifty-two patients had iron studies prior to cancer treatment and 152 had them during treatment. The prevalence of IDA was 15.4% (8/52) at baseline and higher at 23.0% (35/152) during treatment, of which 19 had ferritin < 30 ng/mL. Only 3 (1.1%) patients required treatment interruptions or suspension of systemic therapy due to anemia. There were 58 patients (21%) who received iron repletion and 31 patients (11%) who received packed red blood cell (pRBC) transfusion during cancer treatment. Among the 36 patients (62%) who had follow up iron workup after receiving iron repletion, 95% had ferritin increase, with an average increase of 495 ng/mL. Multivariable analysis showed that chemotherapy (p = 0.029), radiation therapy (p = 0.005) and inflammatory bowel disease (p = 0.023) were independently associated with presence of IDA. Conclusions: In this large cohort of premenopausal breast cancer patients in the United States, both anemia and IDA prevalence were high during therapy. Transfusion and iron repletion are frequently needed. Further investigation is needed to determine the impact of routine iron study and iron repletion on treatment adherence, patient quality of life, and overall clinical outcomes.