(VIDEO: Starr Mautner, M.D., a breast surgeon at Miami Cancer Institute, discusses treatments for breast cancer in young women.)
Women who are diagnosed with breast cancer before age 40 represent a small percentage of the overall number of breast cancer cases each year in the U.S., according to National Cancer Institute research. However, the results of several clinical trials testing contemporary surgery types and chemotherapy, radiation and medication treatments, are showing more promising outlooks and increasing survival rates in young women with breast cancer, according to findings published recently in the Journal of Clinical Oncology [1].
“In addition to addressing how to help these women survive the disease, a breast cancer diagnosis at a young age presents doctors, and patients themselves, with a unique set of considerations, including preserving fertility and lessening the chances of recurrence later in life,” says Starr Mautner, M.D. [2], a breast surgeon at Miami Cancer Institute [3].
Special Considerations for Young Women with Breast Cancer
Among the top issues treating physicians and surgeons must address with this unique patient population are:
- Breast conservation versus mastectomy
- Chemotherapy’s effect on ovaries
- Anti-estrogen therapy
- Timing of pregnancy after treatment
- Reducing risks of cancer recurrence
Young women with breast cancer also are more likely to have aggressive tumors that grow more rapidly, compared with breast cancers in older women.
“For the treating physicians, one of our biggest challenges when developing treatment plans for this special group of patients is striking the delicate balance between minimizing risk of cancer recurrence while achieving optimal outcomes that will provide the best quality of life going forward,” Dr. Mautner said.
Surgical Treatment for Young Women with Breast Cancer
Like most medical treatments, there are pros and cons that accompany the different options for breast cancer surgery. While there is over 30 years of data supporting equivalent survival overall with breast conservation — versus mastectomy — historically these trials did not include many women under the age of 40, Dr. Mautner explains.
“We now know more about the effectiveness of the different surgical approaches to breast cancer in younger women, mainly lumpectomy versus mastectomy,” she said. Lumpectomy followed by radiation may be appropriate for smaller, localized breast tumors. In cases when the cancer is a larger mass, mastectomy may be the appropriate option.
Lumpectomy is a smaller surgery with a shorter recovery time, while mastectomy is generally followed by immediate breast reconstruction and requires an inpatient hospital stay, adds Dr. Mautner. Other factors taken into consideration when deciding on the surgical approach include family history and quality of life.
Dr. Mautner also advises young women with breast cancer to have genetic testing to identify their risk of developing another breast cancer in the future as well as risks of other types of cancer.
“Some young women with breast cancer are more likely than others to harbor genes that predispose them to future cancer diagnoses,” she said. “With the results of advanced genetic testing and proper genetic counseling, these women can become better informed about their risk factors and opt for tailored treatment options that are best for them.”
Pregnancy After Breast Cancer
The American Cancer Society estimates up to 15 percent of young breast cancer survivors become pregnant at least once after their diagnosis.
“Breast cancer has the highest risk of recurring within the first two years after treatment,” said Dr. Mautner. “While there isn’t yet significant data that indicates pregnancy worsens a woman’s prognosis or increases the chance of recurrence, we generally recommend to breast cancer survivors they wait at least two years after treatment before becoming trying to conceive.”
Dr. Mautner adds that it’s important for women who get breast cancer in their childbearing years to know there are different options for treatment.
“While breast cancer in young women is rare, any new palpable abnormality in a young woman needs to be worked up appropriately to rule out a carcinoma,” she says. “When breast cancer is diagnosed, it’s important for the surgeon to work closely with patients’ medical oncologists, reproductive endocrinologists and other specialists who become part of the care team.”
Watch the video to learn more.