In this E-Learning module, the author explores the rising incidence of breast cancer in young women. Risk factors, genetic predisposition, young age as a negative prognostic factor, the question whether treatment in young patients with breast cancer should be more aggressive and how to choose the optimal treatment for hormone receptor-positive disease, are considered. Moreover novel adjuvant treatment options are presented and patient-centred, age-focused questions on fertility preservation, management of early menopausal symptoms, bone health management, pregnancy after breast cancer and the impact of breast cancer diagnosis on quality-of-life (QoL) are addressed.
Breast cancer is the most common malignancy in young women. It is characterised by unfavourable genomic features and aggressive clinical course. Testing for high penetrance mutations may offer individualised surveillance, family management and treatment options. However, in terms of standard treatment, surgery, radiotherapy and chemotherapy should be considered both for young and for older patients with breast cancer.
In terms of considerations for hormone-receptor-positive disease, the author underlines that those patients with involved lymph nodes and those with N0 plus an Oncotype recurrence score >16, benefit from chemoendocrine therapy. Preferred endocrine treatment in young women with hormone receptor-positive breast cancer is aromatase inhibitor plus ovarian suppression, while tamoxifen is sufficient for low-risk patients. However, the author emphasizes low treatment adherence.
With regard to novel options for the adjuvant treatment, the author summarises the results from the studies with adjuvant CDK4/6 inhibitors plus endocrine therapy in subgroups of premenopausal patients, as well as with adjuvant olaparib in BRCA germline carriers.
The final part of the module is focused on a range of patient centred issues, important for QoL of young women with breast cancer, pointing out to the importance of fertility preservation, as pregnancy after breast cancer is not contraindicated and the necessity of providing supportive care.
