- To provide an update on risk factors, genetics, biology, clinical-pathological features and prognosis of breast cancer in young women
- To provide an update on medical treatment of breast cancer in young women
- To increase awareness among medical oncologists on how young women with breast cancer are more likely to suffer both physically and emotionally compared to older patients, and to discuss the problems they face with regard to their sexual health, body image, and fertility problems and how to address these problems
This E-learning module is part of ESMO’s activities to educate medical oncologists about the specific characteristics of cancer in young adults. Breast cancer in young women occurs at a time in life which is usually reserved for family and career. Therefore, issues related to treatment, recovery and survivorship are of particular importance and the aim of this ESMO module is to prepare medical oncologists for the specific features of breast cancer in this group of patients. New data is also presented in this E-learning module that can be incorporated into the care of young women with breast cancer.
The incidence of breast cancer in women younger than 40 years is 6,5% and 0,6% in women younger than 30. Incidence rates in this age group remains stable over the years. However, breast cancer at a young age is associated with unique risk factors, adverse clinical-pathological features, and poorer prognosis.
Several genes are associated with hereditary susceptibility to breast cancer, most notably the BRCA1 and BRCA2 genes. Other less common gene mutations which confer elevated breast cancer risk are associated with Cowden syndrome, Li-Fraumeni syndrome, Peutz-Jeghers syndrome, ataxia-telangiectasia heterozygosity and hereditary diffuse gastric cancer. Genomic studies illustrate a rich biology among breast cancers arising in young women, with adverse prognostic features appearing more frequently in very young patients. Age younger than 35 appears to be an independent adverse prognostic factor for premenopausal patients with breast cancer. The prognostic effect of age varies by tumour subtype.
Although age affects prognosis in breast cancer patients, it does not greatly affect treatment. Treatment options are based primarily on the stage of disease and tumour characteristics, such as tumour grade, hormone receptor status, and HER2 status. However, breast cancers in younger women are more likely to be fast-growing, higher-grade and hormone receptor negative. Each of these factors makes breast cancer more aggressive and more likely to require chemotherapy.
Local and systemic treatments should be considered in a similar way for young and older women. However, menopause status plays a role in the choice of certain treatment options over others. For example, aromatase inhibitors are only used to treat postmenopausal breast cancer and are not an option for premenopausal women unless ovarian suppression is also part of the treatment. Emerging data on hormonal therapy provide more options for endocrine therapy. In this module, the author discusses the studies investigating the optimal duration of endocrine therapy in young women with breast cancer.
Both chemotherapy and tamoxifen can induce amenorrhea and premature menopause. A significant part of this presentation is dedicated to the suppression of ovarian function and methods to preserve fertility during breast cancer treatment. The author also discusses menopausal symptoms and strategies to ameliorate them in young breast cancer patients. Since chemotherapy causes accelerated bone loss, bone health and the use of biphosphonates in young women with breast cancer is also discussed in this module. In general, young women with breast cancer are more likely to suffer both physically and emotionally than older women and this module covers the specific concerns that should be addressed in this patient population.
This E-Learning module was published in 2016 and expired in 2018.
The author has reported no conflict of interest.