Breast Cancer in Young Women

While the risk of breast cancer increases with advancing age, young women can also develop the condition. Approximately one third of women with breast cancer are diagnosed prior to menopause, and approximately 7 percent of breast cancers are diagnosed before the age of 40. Only around 1 percent of breast cancers occur before the age of 30.

Age does tend to matter when it comes to breast cancer. There are a number of reasons for this, but the most important one is that the disease is more invasive/aggressive in young women than it is in older women. Unfortunately, breast cancer in young women is often relatively advanced by the time it is diagnosed. And the microscopic characteristics of breast cancers in young women are usually characterized by the features of difficult to treat breast cancers.

Breast cancer and its treatment can cause a number of life-altering health issues for anyone, but especially for young women, particularly because it can impact fertility and cause premature menopause. In addition, some of the effects of the disease may take decades to appear.

There are a number of risk factors associated with breast cancer, but no avoidable causes have been identified. Young women who develop breast cancer are more likely to have a genetic predisposition to the disease than older women are.

Additionally, some risk factors for premenopausal breast cancer include:

• Recent birth control use
• A history of mantle field radiation for Hodgkin lymphoma
• Early age of menarche (first period)
• High intake of red meat

High vitamin D levels, regular physical exercise, and a high intake of fruits and vegetables have been associated with a lower risk of premenopausal breast cancer. And childbearing plays a role in the risk of breast cancer too: Having children earlier in life, and having more children, is associated with a lower risk of developing breast cancer later on.

While screening mammograms are advised for women who are 40 and over, this screening is not considered efficient for women under age 40 (with a few exceptions).

Because most young women do not have regular screening, around four out of five young women with breast cancer are diagnosed when they develop a palpable breast lump. Breast lumps are often a sign of late-stage breast cancer, while earlier stages can usually only be detected with a mammogram. (Breast cancer staging is a description of how much the tumor has grown and spread.)

Women who develop breast cancer in the premenopausal years are more likely to have a higher tumor grade. The tumor grade is a measure of the aggressiveness of a tumor based on its cell type ("high-grade" corresponds to tumors that are likely to grow and spread rapidly).

There are also certain molecular characteristics that differentiate the types of breast cancer. Triple-negative breast cancer, which is difficult to treat and has a low survival rate, is more common in younger women.

Breast cancers in young women are less likely to be estrogen receptor- or progesterone receptor-positive. And, young women with breast cancer are more likely to be HER2-positive.

All of these factors affect treatment options and prognosis.

The treatment options for breast cancer in young women often differ from those of older women. Not only do the molecular characteristics of tumors differ (for example, estrogen receptor-positive versus estrogen receptor-negative), which makes some therapies better than others, but a woman's menopausal status and risk of long-term complications need to play a major role in the creation of a treatment plan.

One of the decisions women with breast cancer have to make is choosing between a lumpectomy and a mastectomy.

A mastectomy may carry a greater emotional impact than a lumpectomy, as it requires more extensive surgery and produces a major alteration in a woman's physical appearance. However, a mastectomy may be more effective in preventing a recurrence.

Women who are treated for early-stage breast cancer under the age of 36 have a 13 percent chance of developing another cancer in the same breast or in the other breast during the following 10 years.

Chemotherapy can decrease the risk of cancer recurrence. However, chemotherapy can produce major side effects, including infertility, risk of birth defects and pregnancy complications in future pregnancies, premature menopause, and development of other types of cancer.

Removal of the ovaries (oophorectomy) or treatment with medications that suppress ovarian function are more commonly used as part of breast cancer management for younger women than for older women. The consequences include premature menopause and infertility, as well as estrogen deficiency, which can produce its own complications, such as osteoporosis.

Since HER2-positive tumors are slightly more common in young women, HER2-targeted therapies (such as Herceptin) can often be used for the treatment of breast cancer.

With the approval of these therapies, the National Cancer Institute (NCI) upgraded the prognosis for stage I to stage III HER2-positive breast cancer from "fair" to "good."

Menopause-like symptoms can be difficult for young women being treated for breast cancer. Rather than the gradual onset of hot flashes associated with menopause, these symptoms can come on seemingly instant after chemotherapy begins.

Sexual side effects are common with lower estrogen levels, and these can be particularly bothersome for young women.

Chemotherapy can increase the risk of birth defects and may decrease fertility. For those who want to have kids in the future, there are options for preserving fertility, including freezing your eggs or, if you have a partner, preserving one or more fertilized embryos.

The flip side of this concern is that some people remain fertile even during treatment. For those who have used oral contraceptives, these are no longer an option due to the estrogen in the Pill. Other methods of contraception, such as condoms or an intrauterine device (IUD), are recommended.

Some effects of breast cancer and its treatment take many years to develop. Young women, in general, are expected to live much longer than older women, making them more likely to experience the long-term effects of these treatments:

• Chemotherapy: Peripheral neuropathy, low bone density, osteoporosis, and bone fractures
• Radiation therapy: Risk of secondary cancers (cancers that develop due to the carcinogenic effect of radiation)

The survival rate for young women with breast cancer is lower than that for older women with the disease.

Part of this disparity has to do with the diagnosis at a later stage. But, the types of breast cancer that occur in younger women tend to be more aggressive and more likely to spread and recur, even after treatment.

And, when breast cancer recurs in younger women it is more likely to be a metastatic recurrence than a local recurrence.

Support groups and communities can make a tremendous difference when you have breast cancer. A caveat, however, is that it's helpful to find a group that includes other young women. The issues you are facing as a young woman are considerably different from those a 60- or 70-year-old woman may be facing.

Coping with the emotions of breast cancer, as well as anxiety or depression, is difficult for anyone of any age. Talking with a cancer therapist can be very helpful and has been correlated with improved survival rates for people with breast cancer.

Caring for young children can be challenging when you have breast cancer. At the same time that you are dealing with your own emotions, your responsibilities in taking care of your children can leave you little to no time for self-care.

Being involved in a breast cancer community with other young mothers can be valuable and may point you to useful resources in your community.

Careful decision making is imperative for every woman with breast cancer, and weighing the options can be even more difficult if you are young. Aggressive treatment is often recommended due to the greater risk of recurrence, but this also means a high chance of experiencing the late effects of cancer treatment.

It goes without saying that a cancer diagnosis at any age is not welcome news. It may somewhat help to know that many patients (and experts) say that the experience, while challenging, can change you in some positive ways in the end. Have a focused treatment plan, lean on those around you for support, and always keep the hope of the years ahead as a reminder of why you're fighting your fight.